,
.'"v':'l
APR 1 1952
OF TH E
•School oji^edicina
Digitized by the Internet Archive
in 2011 with funding from
LYRASIS Members and Sloan Foundation
http://www.archive.org/details/bulletinofuniver3636
Bulletin
OF THE
SCHOOL OF MEDICINE
UNIVERSITY OF MARYLAND
Vol. 3 6
195. 1
L. 4-
OF
THE SCHOOL OF MEDICINE
UNIVERSITY OF MARYLAND
volume 36 January, 1951 number i
EDITORIAL
ABDOMINAL PAIN
As time goes on, there are more and more laboratory aids and scientific tests to
point to correct diagnoses of diseases and conditions that are not normal. It is nat-
ural that we should lean more on the new and less on the old. There are countless
illustrations of this over the ages, but it is not the part of wisdom to discard or dis-
count fundamental symptoms and signs that are nature's way of issuing warnings.
Pain is, of course, a fundamental symptom of many conditions. It is unfortunate
that some of our worst diseases do not in their early stages give rise to this signal.
When it does occur, it justifies all the consideration given it by our predecessors
and more, for we have the benefit of modern knowledge that has been developed in
the fields of anatomy, physiology and pathology, which add to the value of this
symptom. One seems to note, however, in recent years a certain indifference or
casualness in the attempts at its interpretation. It is not meant that there is indiffer-
ence to its relief, but to question whether it is always given the careful analysis that
can be so very revealing.
In considering pain, it is probably more important than in most any other com-
plaint, to evaluate the patient first and the symptom second, and in this problem
there are dangers. It is safer in most instances to err on the side of believing rather
than disbelieving.
In a brief article one cannot discuss the vagaries of children, the malingering of
those receiving compensation, and other cases in litigation, nor the hysterics. In the
usual bona fide cases, one should carefully listen to the description of the pain, at-
tempting to get the patient to tell in his own words just what is felt. The choice of
words in many of these histories is very descriptive.
We cannot here go into a detailed scientific discussion of pain. It is a most com-
plex subject and it is wondered whether sufficient attention is paid to it per se in
our teaching. If the complaint is in the abdomen one should take the time to obtain
from the patient the characteristics of the pain; whether deep or superficial, dull or
sharp, local or general, steady or rhythmic; whether it is throbbing; whether re-
ferred along well established paths: are the pain and tenderness in the same area;
is there rigidity; is there nocturnal or diurnal emphasis; does the position of the pa-
tient influence the severity; is the pain accompanied by visible peristalsis and bor-
borygmi.
2 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID.
It should be remembered that strangulations of bowel are likely to give more ag-
gravated symptoms than obturator types of obstruction. Evans and Bigger, in the
J. A. M. A. February 22, 1947 state:
"Pain is the commonest symptom in obstruction of the small bowel. Although it
is generally stated that in both types of obstruction the onset is sudden, we are im-
pressed by the dramatic onset of pain in strangulating obstruction; it is likely to
be sudden and severe, even violent. In this respect the patient with strangulation
resembles those of other clinical states where the flow of blood to a part is suddenly
obstructed as in coronary occlusion or embolus to a main artery of an extremity. In
simple obstruction the patient may recall that in the earliest hours there had been
abrupt, periodic increase and cessation of the pain, but in strangulation the pain is
generally continuous without intervals of complete freedom from pain".
A large bowel obstruction not caused by strangulation may be accompanied by
little pain, and when it is present there may be surprisingly long intervals between
paroxysms, thus throwing the doctor off guard. The patient seems at times to have
been relieved — only to have other paroxysms. A Wangensteen suction will in many
instances relieve the pain of obstruction and while being helpful may lull the pa-
tient and doctor into greater danger.
One has only to review cases in retrospect to realize that a more critical analysis
of the type of pain might have lead to a more correct diagnosis. More care might
have promptly pointed to the chest condition giving abdominal symptoms, or an
abdominal condition giving chest symptoms, or cerebro spinal disease giving ab-
dominal symptoms. We find instance after instance where the persistence of pain
finally leads to the diagnosis of biliary tract disease, colonic growths and other con-
ditions in spite of negative roentgenologic and laboratory findings.
Many examples of interesting and confusing problems could be cited but perhaps
enough has been said to emphasize the importance of paying attention to the pa-
tient's complaint of pain. An attempt should be made to analyze pain on its own
characteristics, with corroboration from available tests. It is not wise to depend
entirely on laboratories to tell what nature in her outcry may be saying rather
plainly.
Walter D. Wise, M.D.
CANCER DETECTION AND THERAPY
II. Methods of Preparation and Biological Effects
of Metallo-Porphyrins* f t
LOUIS 0. J. MANGANIELLO, M.D.§ and FRANK H. J. FIGGE, Ph.D.
In a previous paper (1), the affinity of neoplastic and growing tissue for porphyrins
and metallo-porphyrins (zinc hematoporphyrin) was reported. When mice with in-
duced (methylcholanthrene) or transplanted tumors (Sarcoma 37, Sarcoma 180) and
a dog with a spontaneous mammary tumor were injected with radioactive zinc hema-
toporphyrin, the tumors became very red fluorescent, although not as radioactive
as had been anticipated. On the other hand, the liver became two or three times as
radioactive as the tumor, and contained very little porphyrin. Further investigation
involving the injection of radioactive zinc hematoporphyrin into normal dogs, rab-
bits, and mice, confirmed the impression that zinc 65 was split off the porphyrin and
stored in the liver.
It thus became desirable to test other more stable metal porphyrin compounds in
the hope of finding one or more that would not be broken down in the liver. When
the methods for synthesizing metallo-porphyrin compounds were examined, it was
found that in some instances the existing methods were quite simple. However, some
metals had not been introduced except by pressure bomb synthesis (vanadium) (2)
because the solvents commonly employed boiled far below the temperature neces-
sary for the reaction. It appeared probable that any metal porphyrin complex could
be made if a mutual solvent for the metal salts and the porphyrin, with a boiling
point near 200° Centigrade could be found. Ethylene glycol with a boiling point
near 200° Centigrade was tried and proved to be ideal in every respect. In addition,
it was miscible with water and the boiling point could thus be regulated.
The method involving the use of ethylene glycol as a solvent will be described
below. For comparison of yields and properties of the compound made by other
methods, the preparation of zinc hematoporphyrin will be described. The fate of
this compound in the bodies of animals with tumors will be discussed.
METHOD. AND MATERIALS
Preparation of Zinc Hematoporphyrin
method 1— method of fisher, treibs and hummel as modified by glenn s. weiland
(methyl-alcohol method)
Five hundred mg. (0.74 millimoles) of hematoporphyrin dihydrochloride is dissolved in 30 ml. of
50 per cent (v/v) solution of methanol and added with vigorous stirring at room temperature to a
solution of 330 mg. (1.48 millimoles) of zinc acetate dihydrate dissolved in 15 ml. of methanol. Some
* This work was supported by grants from the Anna Fuller Fund, the Damon Runyon Fund and
Merck & Company, Inc.
f From the Departments of Neurosurgery and Anatomy of the University of Maryland School
of Medicine, Baltimore, Maryland.
t Received for publication November 2, 1950.
§ Fellow in Neurosurgery. Fund B.
3
4 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
precipitation of the zinc porphyrin appears. After a few minutes, while stirring vigorously, there is
added to the mixture 50 ml. of water. The precipitated metal porphyrin is then filtered and washed
3 or 4 times with 30 ml. of water until the filtrate is free of zinc and chloride ions. The material is
dissolved in dioxane which is then evaporated in a hood. The yield by this method is 648 mg. of
zinc hematoporphyrin.
METHOD 2 — ETHYLENE GLYCOL METHOD
Five hundred mg. of hematoporphyrin dihydrochloride is dissolved in 200 cc. of ethylene glycol.
Next, 350 mg. of zinc acetate dihydrate is dissolved in 25 cc. of ethylene glycol. Both solutions are
heated to 90 C. and mixed with vigorous shaking. Heating is continued until the solution changes
from a red fluorescent color to an orange-yellow fluorescence. Next, 750 cc. of water is added. When
TABLE I
Solubility and Fluorescence of Zinc Hematoporphyrin Samples in Various Solvents
Acetic acid
Acetone
Ethyl acetate . .
Ethyl alchol . . .
Methyl alcohol
Ether
Dioxane
Ethylene glycol
Benzine
Pyridine
NaOH l.N. ...
Water pH 10 . .
Water pH 8...
Water pH 7 . . .
Water pH 5
0.1 NHC1
1 N HC1
2 NHC1
H2SOi
ETHYLENE GLYCOL METHOD
METHYL ALCOHOI METHOD
Soluble
Fluorescence
Soluble
Fluorescence
slightly
yellow-orange
slightly
yellow-orange
slightly
yellow-orange
slightly
yellow-orange
slightly
yellow-orange
slightly
yellow-orange
slightly
yellow-orange
slightly
yellow-orange
slightly
yellow-orange
slightly
yellow-orange
slightly
yellow-orange
slightly plus
yellow-orange
soluble
yellow-orange
soluble
yellow-orange
slightly
yellow-orange
slight lv
yellow-orange
slightly
?
slightly
yellow-orange
soluble
red-orange-yellow
soluble
orange-yellow
very
dark yellow
very
light yellow
soluble
orange-yellow dark
soluble
orange-yellow
soluble
orange-yellow dark
soluble
orange-yellow light
slightly
orange-yellow dark
slightly
orange-yellow light
insoluble
nonfiuorescent
insoluble
nonfiuorescent
insoluble
slightly red
insoluble
slightly red
slightly
orange-yellow
slightly
orange-yellow
slightly
orange-yellow
slightly
orange-yellow
decomposed
dark red
decomposed
dark red
warmed, a flocculant precipitate forms, which settles out on standing. After removal of the superna-
tant liquid, the precipitate is filtered and washed three to four times with distilled water. The pre-
cipitate is then collected by dissolving it in dioxane and is weighed after the evaporation of this
solvent (in hood). The yield by the above is 461 mg. zinc hematoporphyrin.
RESULTS
Comparison of the Yields, and Properties of the Products
The fact that the yield by the methyl alcohol method was considerably higher
(641 mg) than the yield with the ethylene glycol method (461 mg) was related to
the fact that the product obtained by the methyl alcohol method was a gummy
resin-like substance that could not be completely dried. In contrast, the material
obtained by the ethylene glycol method was a fine dry powder. The solubility and
fluorescence of the preparations were determined and listed in Table I.
MANGANIELLO AND FIGGE— CANCER DETECTION AND THERAPY 5
Ten mg. of the zinc hematoporphyrin of each sample was placed in 20 cc of sol-
vent. The degree of solubility and fluorescence color and intensity were estimated
by visual inspection and comparison. The solutions were examined two hours after
preparation and again, one week later (see Table I). The fluorescence and absorp-
tion spectra were determined by means of a Hartridge reversion spectroscope. The
TABLE II
Fluorescence and Absorption Spectra of Zinc Hematoporphyrin
METHYL ALCOHOL METHOD
ETHYLENE GLYCOL METHOD
SOLVENT
Fluores-
cence band
(Angstrom
units)
Absorption bands
(Angstrom units)
Fluores-
cence band
(Angstrom
units)
Absorption bands
(Angstrom units)
Edge
Center
Edge
Edge
Center
Edge
Acetic acid
619.2
577.5
584.0
551.1
575.4
537.0
566.4
525.4
619.2
577.4
587.1
551.2
576.5
538.1
568.2
526.0
Acetone
611.8
570.4
586.5
553.4
575.6
539.0
565 . 7
523.5
612.8
571.8
585 . 8
551.8
576.3
539.9
560.1
529.0
Dioxane
609.2
571.4
586.3
553.8
576.2
538.8
566.4
521.0
610.8
571.8
587.6
554.6
577.3
538.8
567.1
523.8
Ethylene
glycol
627.8
571.5
582.5
550.2
577.4
540.6
572.6
528.0
627.8
571.5
583.5
549.6
578.0
540.4
571.2
530.8
Methyl
alcohol
625.8
585.6
585.4
553.4
576.3
539.8
569.8
528.0
625.8
583.7
589.8
556.0
577.9
539.9
568.5
524.0
NaOHO.lN
624.6
572.8
589.2
554.5
578.6
539.8
568.2
524.8
625.2
572.8
589.8
554.2
580.0
541.2
569.9
525.6
data were recorded in Table II. These spectroscopic data made it possible to identify
the porphyrins or metalloporphyrins in the tissues, even without extraction. To per-
mit differentiation, similar absorption and fluorescence spectra were determined for
hematoporphyrin and hemin. These are also listed in Table II-A. Attempts to deter-
mine the melting points of the above compounds were unsuccessful.
A number of other metal porphyrins have been prepared by the ethylene glycol
method. These compounds and their biologic effects will be described later.
6 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
An attempt was made to determine the toxicity of zinc hematoporphyrin and
zinc 65 hematoporphyrin. Experience with the injection of hematoporphyrin into
animals (mice, rabbits and dogs) and human subjects led to the conclusion that
hematoporphyrin itself was not as toxic as reports indicate (3). Mice readily tol-
erated doses of 10 mg. of hematoporphyrin if they were not exposed to direct sun-
TABLE II-A
Fluorescence and Absorption Spectra of Hematoporphyrin HCl and Heme
HEMATOPORPHYRIN HCl
HEME
SOLVENT
Fluorescence band
A
Absorption bands
A
Center
Absorption bands
A
Center
Acetic acid
605.6
598.9
573.6
554.3
546.0
526.6
Acetone
626.1
624.4
590.5
643.2
570.6
589.9
532.3
Dioxane
626.2
623.1
596.9
643.7
574.4
547.4
532.9
519.3
Ethylene glycol
603.8
610.4
563.9
529.4
496.0
618.3
Methyl alcohol
603.0
625.9 (wide)
610.1
563.0
526.9
497.0
NaOHO.l N
616.4
620.2
569.5
609.4
540.0
502.7
light. Rabbits were given 25 to 50 mg. of hematoporphyrin with no undesirable
effects. It was noted that when normal mice, or mice with tumors, were injected
with metalloporphyrins, the mice with tumors tolerated a much larger dose than
the normal mice. A preparation of zinc 65 hematoporphyrin, prepared by the Trac-
erlab Company under direction of Glenn S. Weiland, was injected into normal mice
with transplantable tumors, rabbits and normal dogs, and a dog with a spontaneous
mammary carcinoma. Normal mice tolerated doses of 2-4 mg. while mice with tu-
MANGANIELLO AND FIGGE— CANCER DETECTION AND THERAPY 7
mors tolerate 2 total daily doses of 5-8 mg. Two dogs, one with spontaneous mam-
mary carcinoma, were injected with 28 and 66 mg. without toxic symptoms.
No ill effects of these injections were noted. Mice and the dog with malignant
tumors concentrated some zinc 65 hematoporphyrin in the tumors, which became
very red fluorescent. Most of the fluorescence appeared to be related to the presence
of hematoporphyrin. The survey of the larger animals (rabbits and dogs) with a
Geiger counter, revealed that the liver had 6-8 times as much radioactive zinc as
the tumors. There was no fluorescence spectrum characteristic of zinc hematopor-
phyrin. It was assumed that the liver had removed and had stored the zinc 65
from the injected matter. It took about 9-12 months for the zinc 65 to leave the
liver completely.
On the basis of the above studies, eight human subjects with malignant neoplasms
were injected with 10-100 mg. with no noticeable toxic effects.
CONCLUSIONS
1. Zinc porphyrin was not stable enough to be useful for cancer detection and
therapy. The search for more stable metalloporphyrins is now in progress.
2. A new method for preparation of metalloporphyrins is presented.
BIBLIOGRAPHY
1. Figge, F. H. J., Weiland, G. S., and Manganiello, L. O. J.: Cancer detection and therapy.
Affinity of neoplastic, embryonic, and traumatized tissues for porphyrins and metalloporphy-
rins. Proc. Soc. Exp. Biol, and Med., 68: 640-641: 1948.
2. jFischer, H., Treibs, A., and Hummel, G. : Zur Kenntnis der naturlichen Porphyrine uber Hama-
toporphyrin. Ztschr. f. physiol. Chem., 185: 33-73, 1929.
3. Myer-Betz, F. : Untersuchungen uber die biologische Wirkung des Hamatoporphyrin und
anderer Derivate des Blut und Gallenfarbstoffes. Deutsches Arch. f. klin. Med., 112: 476-503,
1913.
THE "LENTICULO-STRIATE ARTERY"*f
ELINOR W. DEMAREST, M.D.,J
The existence of the lenticulo-striate artery, Charcot's artery of cerebral hemor-
rhage, as a definite entity has been seriously questioned. A survey of the original
and current work on this artery reveals a general vagueness of terminology and
an indefiniteness in the description of its course. From this, the 3 following questions
arise: 1) Is there a constant lenticulo-striate artery, the so-called artery of cerebral
hemorrhage of Charcot; 2) Are there proved cases of its rupture; 3) What is the
status of this artery in the current textbooks?
In 1868 Charcot (1) published a paper on his work on cerebral hemorrhage in
which he reported 77 cases, 69 of which were hemorrhages at the base of the brain.
The localization of the hemorrhage was not well defined nor was any attempt made
to dissect out the involved vessels. Only 3 sites of rupture were found. This work
constituted the foundation for his statement that cerebral hemorrhage occurs most
frequently in the base of the external capsule anteriorly and then spreads through
the lenticular nucleus to the internal capsule. He labelled the point of origin the
"site of election" for cerebral hemorrhage.
Charcot instigated Duret to investigate the arterial supply of the brain and the
latter produced the first complete monograph on the subject in 1874 (2). The study
of the distribution of the arteries to the corpus striatum was done by injecting the
arteries, (no technique for this was given in the paper), and by then making two
transverse sections through the brain. One was made "just a little behind the chiasm
of the optic nerves." In this section he described the middle cerebral artery running
over the perforated space for a distance of 1 centimeter and then disappearing be-
hind the section of the posterior cerebral lobe, "in this interval it gives off of its su-
perior border the arteries to the corpus striatum." Duret's description (translated)
of these arteries was as follows: "One can divide these arteries into two groups.
The external ones are very voluminous. The internal ones, situated near the vertex
of the lenticular nucleus, are very small. Among the first group there is always one
which goes for a certain distance along the base of the lenticular nucleus on the mar-
gin of the external capsule in order to reach the caudate nucleus where it divides
into four or five terminal branches which we find on the second section. It is this
artery which, after our studies at Salpetriere and after the teaching of Charcot, lies
in the location of predilection of hemorrhage of the corpus striatum. This arteriole
supplies many collateral branches to the third segment of the lenticular nucleus.
There are still two or three external branches which go in front of the third segment
of the lenticular nucleus and finally reach the end of the corpus striatum. This group
of external arteries are called the lenticulo-striate arteries."
No dissection of these arteries was made for fear of rendering the structures
* From the Department of Pathology, Division of Neuropathology, University of Maryland
School of Medicine, Baltimore.
t Received for publication September 1, 1949.
J University Hospital, Baltimore.
DEMAREST—THE LEX TICU LOST RI ATE ARTERY 9
through which they passed unrecognizable. Duret makes no mention of the number
of brains examined in making the above description.
So Duret divided the basal branches of the middle cerebral artery into an external
group, which he called the lenticulo-striate arteries, and an internal group, called
the lenticulo-optic arteries. He described one of the former group as being constantly
located in the area already designated by Charcot as the site of predilection for cere-
bral hemorrhage.
In the same year Heubner (3) published a paper on the circulation of the brain
in which he did not name the basal branches of the middle cerebral artery. His work
was done by injecting single arteries, piece by piece, and noting the part of the brain
each piece supplied by sectioning the brain. He performed 60 injections on 30 brains.
Heubner gave the location of origin of the arteries to the corpus striatum and de-
scribed them as "those little arteries which supply the putamen and the middle part
of the caudate nucleus and the external capsule." He made no attempt to differen-
tiate or to name these arteries. He also contradicted many of Duret's other findings.
Among Duret's comments on Heubner's work (4) was the statement that Heub-
ner was too precise in his description of the origin of the arteries to the corpus stria-
tum and that Heubner did not see the difference which existed between the internal
and external (or lenticulo-striate) arteries.
In his lectures of 1876-1880 (5), Charcot incorporates Duret's description of the
lenticulo-striate arteries stressing the importance of one of them because of its size
and predominant role in intra-encephalic hemorrhage. He states, "It appropriately
could be called the artery of cerebral hemorrhage" and describes its course as enter-
ing the third segment of the lenticular nucleus, then transversing the superior por-
tion of the internal capsule and entering the body of the caudate ganglion. It then
continued from behind, forward to the most anterior part of that ganglion.
Kolisko (6), in 1891 introduced further corrections to Duret's work, mainly con-
cerning the field of supply of the anterior choroidal artery. His work also was done
by injection and section of the brain. No terminology is given to the basal branches
of the middle cerebral artery.
The area of supply of the middle cerebral artery differed in all of the above cited
works.
In 1909 Beevor (7) produced a survey of the maximum distribution of the major
vessels based on the examination of 87 brains, but he paid little attention to the de-
tails of distribution of the smaUer arteries. He injected simultaneously the major
vessels, using four different colors. He showed variations in the areas supplied by
each artery in the different brains. In coronal sections he thought that the curved
arrangement of the area of the middle cerebral supply followed the course of the
lenticulo-striate and lenticulo-optic arteries of Duret, but Beevor made no attempt
to define or trace these vessels. He outlined more definitely the area of supply of the
middle cerebral artery (8).
Aitken (9), in 1909, published a series of figures of the arteries to the basal gan-
glia based on actual dissection of the individual vessels, based on an examination of
45 brains. He reproduced Duret's figure of the arteries to the corpus striatum and
claimed that the caliber of Charcot's artery was greatly exaggerated. Figures were
10 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
then given from textbooks of the day which had adopted Duret's findings. There
is a gradual progress of the original error in the drawing until the so-called Charcot's
artery is pictured lying practically in the external capsule for its entire length and
arriving ultimately nowheres. Aitken suggested that this is the trend of the pic-
torial future of this region if it is allowed to develop along the lines of credence. He
denied the existence of any branches going to the optic thalamus, the lenticulo-optic
arteries of Duret.
Duret (10) defended his work against Aitken's criticisms by saying that his sec-
tions are "demi-schematiques" because it was impossible to do otherwise, "since
the arteries do not occupy only one position." This is in direct contradiction to his
previous claim of constancy in the location of Charcot's artery in his original article
(2). He claimed that Aitken reproduced the diagram, which accompanied Charcot's
Lectures on Localization in Diseases of the Brain, and in which the volume of the
artery of hemorrhage (Charcot's) was exaggerated and the drawing was schematic
on the demand of Charcot, for the necessity of his demonstration. Duret concluded
from the recent work done on the vascularization of the corpus striatum, that there
are important variations in the origin and distribution of these arteries and in their
courses.
Ludlum (11), in 1909, was the first to cast skepticism upon the lenticulo-striate
artery. His work also was done by injection. He found that the striate vessels varied
in size from all very small ones in some brains to a fewer number and larger size in
others, and that, in their path, no one arteriole seemed any larger than any other.
He questioned the legitimacy of naming any artery the lenticulo-striate artery and
calling it the artery of cerebral hemorrhage, "not withstanding Charcot." In all of
93 cases of hemorrhage he could not find any artery sufficiently larger than another
to be worthy of a name peculiar to itself. The hemorrhage and softenings were in
different areas in each case. He demonstrated that the anatomy of the striate vessels
is not always constant. He could not find any lenticulo-striate vessels coming up in
the line of the external capsule, Charcot's area of predilection. He found that they
arose more centrally in the lenticular nucleus and nourished the nucleus to this
line of the external capsule.
This was the first article in which the name lenticulo-striate was applied to any
one artery and used synonymously with Charcot's artery of cerebral hemorrhage.
Duret used the name lenticulo-striate to apply to a group of branches of the middle
cerebral artery. Charcot's artery was one of this group. This is apparently one of the
steps which has led to the present confusion in the description of the basal branches
of the middle cerebral artery.
Beginning in 1919, there was much investigation relating to the morphology of
the corpus striatum and its blood supply. These authors have called the basal
branches of the middle cerebral artery, the striate arteries, and have divided them
into a mesial and lateral group, replacing the lenticulo-optic and lenticulo-striate
groups of Duret.
Elliot Smith (12) in 1919 commented on the constancy of the position and rela-
tions of the lateral striate artery in every order of mammals. He found in the turtle's
brain that there was given off from the middle cerebral artery, as it crossed the endo-
DEM A REST—THE LENTICU LOST RI ATE ARTERY 11
rhinal fissure, an exceptionally large perforating artery (or several arteries), which
passed into the brain along the boundary line between the palaeostriatum and the
hypopallium. He claimed that in mammals of every order, one or more large arteries
entered the brain at the identical spot, that is, the postero-lateral corner of the tuber-
osum olfactorium, immediately in front of the tubercle of the olfactory tract and
to the inner side of the olfactory tract. "The artery that enters at this point in the
human brain is the vessel which Charcot called the artery of cerebral hemorrhage."
But as Elliot Smith describes his findings, he says one or more arteries enter at this
point. So then, following his reasoning, there are one or more arteries which should
be called the arteries of cerebral hemorrhage.
In 1920 Shellshear (13) published his work done by injecting the middle cerebral
artery. He referred to Duret as picturing the claustrum being supplied in part by
"branches of the lateral striate artery." Duret, in the work sited by this article (2)
makes no use of this name.
We have thus progressed from Duret's "lenticulo-striate arteries," to Ludlum's
"the lenticulo-striate artery," and now to Shellshear's "the lateral striate artery."
Shellshear (13) described the middle cerebral artery as supplying antero-lateral
branches which perforated the anterior perforated space. These branches further
divided into the mesial and lateral striate arteries.
Abbie summarized the above works (14, 15) and in 1937 (16) pointed out that
clinicians, generally, accept and teach Duret's original findings with little or no
appreciation of the corrections made since 1874. He stated that they still discuss
the lenticulo-optic artery despite the fact that it has no existence. "The term len-
ticulo-striate artery is still retained, although the name is misleading, implying some
distinction between the lenticular nucleus and the corpus striatum, and has been
replaced in anatomical teaching by the title, lateral striate arteries." He described
the middle cerebral artery as giving rise to a number of large branches of different
sizes which enter the brain just anterior to the attachment of the temporal lobe.
Traced into the cerebral substance, these twigs are found to pass laterally and cau-
dally between the claustrum and the basal mass, into the latter of which they sink at
various intervals. "The largest of these was called the lenticulo-striate artery by
Duret." In this statement Abbie makes the same mistake as did Ludlum. Abbie
goes on to point out that the identification of any individual twig is impossible and
in this paper these vessels are referred to collectively as the lateral striate arteries.
In summary of the above works and in answer to the first question, the
basal branches of the middle cerebral artery can be divided into an external and an
internal group, the former being called the lenticulo-striate arteries after Duret. His
name for the internal group, lenticulo-optic arteries, is omitted because the middle
cerebral artery, as shown by Aitken (9), does not supply the optic thalamus. A bet-
ter nomenclature is that offered by Abbie (16) in which the basal branches of the
middle cerebral artery are called the striate arteries and are divided into a mesial
and lateral striate group of branches. No worker, except Smith (12) who worked
on mammalian brains, was able to confirm Duret's finding of an artery sufficiently
distinctive or constant to be designated by a name, as the artery of cerebral hemor-
rhage.
12 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Cases of Rupture
In a search of the literature for reported cases of rupture of the lenticulo-striate
arteries, only one case could be found. In 1831 Thompson (17) described an aneurysm
or pouch "situated towards the cerebral aspect of the point of bifurcation of the
anterior branch of the first fork of the middle cerebral artery" which had ruptured
at a point away from the main vessel. Since this work was done before the time of
Duret, one cannot be sure that his branch would fall within Duret's lenticulo-striate
arteries.
Shennon (18) in 1915 described multiple aneurysms occurring on the "smaller
branchesof the lenticulo-striate artery." These were found in an "old formal-preserved
brain" in which "the vessels were pulled out of the lacerated tissue surrounding the
area of hemorrhage or were carefully dissected out." The site of the vessel rupture
connected with the hemorrhage could be demonstrated.
It is generally accepted that the most frequent site of intracerebral hemorrhage is
in the region of the basal ganglia, although this was questioned by Ludlum (11).
This area is supplied by both the anterior and middle cerebral arteries. Therefore;
one is not justified in claiming rupture of the branches of the middle cerebral artery
based on the location of the hemorrhage alone. It can be proved only by locating the
site of rupture and by tracing the injured vessel back to its parent artery.
The fact that hemorrhage starts in the anterior portion of the base of the external
capsule, Charcot's site of predilection for cerebral hemorrhage, does not mean that
the artery described by Duret (2) as located at this site has necessarily ruptured.
As Abbie (16) showed, the lateral striate vessels are massed together between the
putamen and claustrum, that is, at the base of the external capsule. So, for a short
time, a large number of arteries of different sizes is concentrated within a very small
volume of cerebral substance. Abbie concluded that the frequency of rupture at this
point depends upon the law of probability rather than upon any inherent quality
of the vessels in this situation. The number of arteries crowded within this small
space is probably twice as great as that to be found in any comparable volume of
cerebral tissue. This, Abbie said, is dependent upon the fact that the rhinal fissure,
through which the majority of the lateral striate arteries enter the brain, has become
doubled upon itself during human phylogeny.
Hemorrhage can then occur from any one of this mass of lateral striate vessels
at this site. There is no evidence that any one of these arteries is more susceptible
to rupture or is more frequently found to be ruptured. The naming of one artery the
artery of cerebral hemorrhage is not justifiable.
Survey of Textbooks
In a survey of thirty current textbooks of anatomy, neuroanatomy, and neurology,
the arteries in question were found to be described as follows:
1. Nine textbooks (19-27) describe Duret's original classification of lenticulo-
striate and lenticulo-optic arteries, one of the lenticulo-striate arteries being called
the artery of cerebral hemorrhage. Wilson (28) states that the existence of the len-
ticulo-optic artery is denied and that of the lenticulo-striate is questioned.
DEMAREST—THE LENTICU LOST MATE ARTERY 13
2. Seven textbooks (29-35), reproduce Ludlum's use of the name lenticulo-striate
to one artery and use it synonymously with the name artery of cerebral hemorrhage.
3. Three textbooks (36-38) describe the branches of the middle cerebral artery
as mesial and lateral striate arteries with the lenticulo-striate artery as a branch of
the lateral striate. Lenticulo-striate artery is used synonymously with the artery of
cerebral hemorrhage.
4. One textbook (39) describes the branches of the middle cerebral artery as the
mesial and lateral striate arteries with the artery of cerebral hemorrhage as a branch
of the latter group.
5. One textbook (40) introduces another nomenclature and calls the basal branches
of the middle cerebral the Putamino-capsular branches. The term the artery of
cerebral hemorrhage is not used.
6. Two textbooks (41, 42) state that the artery of cerebral hemorrhage cannot be
distinguished. The former reference uses the terms lenticulo-striate artery and artery
of cerebral hemorrhage synonymously, denying the existence of both.
7. Two textbooks (43, 44) state that since the secondary branches of the cerebral
arteries vary considerably, they should not be distinguished by name.
8. Four textbooks (45-48) make no reference to naming the basal branches of the
middle cerebral artery.
SUMMARY
1. Duret's classification of the basal branches of the middle cerebral artery is
given. He described a branch of the lenticulo-striate group as lying at the edge of
the external capsule, and called this the artery of cerebral hemorrhage.
2. No other worker examining human brains describes a distinguishably different
artery located in this position.
3. The use of the name lenticulo-striate artery and the artery of cerebral hemor-
rhage as synonymous terms was introduced by Ludlum and is clearly a misquotation
from Duret's work.
4. Since only one case of proved or claimed rupture of the lenticulo-striate arteries
is described in the literature, the name artery of cerebral hemorrhage is not justi-
fiable.
5. From the works studied, the basal branches of the middle cerebral artery can
be divided into an external and an internal group, the former being named lenticulo-
striate arteries after Duret. A preferable nomenclature is that of calling the basal
branches the striate arteries. They may be divided into lateral and mesial groups.
6. The current status of the nomenclature of the basal branches of the middle
cerebral artery, based on a survey of thirty recent textbooks, is presented. It clearly
shows the need for clarification and standardization of the naming of these arteries.
BIBLIOGRAPHY
1. Charcot, J. M., and Bouchard, C. : Nouvelles recherches sur la pathogenie de l'hemorrage
cerebrale, Arch, de physiol. norm, et path., 1: 643, 1868.
2. Duret, H.: Recherches anatomiques sur la circulation de l'encephale, Arch, de physiol., 1:
73, 1874.
14 BULLETIN OF THE SCHOOL OF MEDICINE, V. OF MD.
3. Heubner, O.: Die luetische Erkrankung der Hirnarterien nebst allgemeinen Erarterungen zur
normalen und path, histologic der arterien sowie zur Hirncirculation, Leipzig, 1874.
4. Duret, H. : Recherches anatomiques sur la circulation de l'encephale, Arch, de physiol., 1:
346, 1874.
5. Charcot^ J. M.: Localisations dans les maladies du cerveau, 1876-1880, E. P. Fowler, trans.,
New York, Wm. Wood & Co., 70, 1878.
6. Kolisko, A.: Uber die Bezerkung der Arteria choroidea ant. zum hinteren Schenkel der inneren
Kapsel des Gehirns, 1891.
7. Beevor, C. E.: On the distribution of the different arteries supplying the human brain, Phil.
Trans. Roy. Society, 200: 1-55, 1909.
8. Beevor, C. E.: Cerebral arterial supply, Brain, 30: 403-425, 1908.
9. Aitken, H. F. : Report on circulation of the lobar ganglia, Boston Med. and Surg. Journal,
CLX, 18 Supplement, May 6, 1909.
10. Duret, H. : Revue critique de quelques recherches recentes sur la circulation cerebrale, En-
cephale, 1: 7-27, 1910.
11. Ludlum, S. D. W. : Distribution of encephalic hemorrhage, J. nerv. ment. dis., 36: 705, 1909.
12. Smith, Elliot: Preliminary note on morphology of corpus striatum and origin of neopallium,
Jour, of Anat., LIII, 1919.
13. Shellshear, J. L.: Basal arteries of forebrain, J. Anat., London, LV, 27-35, 1920-21.
14. Abbie, A. A.: Fore-brain arteries, Jour, of Anat., LXVII, 491, 1933.
15. Abbie, A. A.: Morphology of fore-brain arteries, Jour, of Anat., LXVIII, 433, 1934.
16. Abbie, A. A.: Anatomy of capsular vascular disease, Med. Jour, of Australia, 2: 564-568, 1937.
17. Thompson, A.: Case of apoplexy, ensuing upon the rupture of a small aneurysm of a branch
of the middle cerebral artery, Lond. M. and S. Jour., 7: 404-413, 1831.
18. Shennon, E. M. J.: Miliary aneurysms in relation to cerebral hemorrhage, Edinburgh Med.
Jour., 15: 245, 1915.
19. Piersol: Human Anatomy, Philadelphia, Lippincott Co., 1207, 1930.
20. Merritt: Fundamentals of Clinical Neurology, Toronto, Blakiston Co., 174, 1947.
21. Nielsen, J. M.: Textbook of Clinical Neurology, New York, Paul B. Hoeber Inc., 284, 1941.
22. Brain, W. R. : Diseases of Nervous System, London, Oxford Press, 290, 3rd Edition, 1948.
23. Brock, S.: Basis of Clinical Neurology, New York, Wm. Wood & Co., 288, 1938.
24. Jelliffe, S. E., and White, Wm. A.: Diseases of Nervous System, Philadelphia, Lea and Feb-
iger, 739, 1935.
25. Mettler: Neuroanatomy, St. Louis, C. V. Mosby Co., 165, 1948.
26. Tilney and Riley: Form and Functions of the Central Nervous System, 2nd Edition, New
York, Hoeber Inc., 723, 1923.
27. Ptjrves-Stewart: Diagnosis of Nervous Diseases, 9th Edition, Baltimore, Wm. Wood & Co ,
94, 1945.
28. Wilson, S. A. K.: Neurology, Vol. II, Baltimore, Williams & Wilkins, 1052, 1054,1066, 1075.
1946.
29. Bing and Haymaker: Textbook of Nervous Disease, 5th Ed., St. Louis, C. V. Mosby Co.,
438, 1939.
30. Walshe, F. M. P.: Diseases of the Nervous System, 4th Ed., Williams & Wilkins, Balti-
more, 99. 1945.
31. Buzzard, E. F., and Greenfield, J. G. : Pathology of the Nervous System, London, Constable,
117-119, 1921.
32. Kuntz, A.: Textbook of Neuroanatomy, Philadelphia, Lea and Febiger, 3rd Ed., 1945.
33. Looney, W. W. : Anatomy of the Brain and Spinal Cord, Philadelphia, F. A. Davis, 1932.
34. Davis, C. L.: Laboratory Manual of Neuroanatomy, Baltimore, 44, 1945.
35. Wechsler, I. S.: Textbook of Clinical Neurology, Philadelphia, Saunders Co., 343, 1947.
36. Morris: Human Anatomy, 10th Ed., Philadelphia, Blakiston Co., 636, 1942.
37. Muller: Applied Anatomy, Philadelphia, Lea and Febiger, 1938.
38. Globus: Practical Neuroanatomy, Baltimore, Williams & Wilkins, 34, 1937.
39. Cunningham: Textbook of Anatomy, 8th Ed., New York, Oxford Univ. Press, 1226, 1943.
DEMAREST—TBE LENTICU LOST MATE ARTERY 15
40. Grinker, R. R.: Neurology, 3rd Ed., Baltimore, Thomas Co., 573, 1943.
41. Gray, H. : Anatomy of the Human Body, W. H. Lewis, Editor, 24th Ed., Philadelphia, Lea &
Febiger, 571, 1942.
42. Strong, O. S.: Human Neuroanatomy, Baltimore, Williams & Wilkins, 1943.
43. Krieg, W. J. S.: Functional Neuroanatomy, Philadelphia, Blakiston Co., 367, 1942.
44. Elliott, H. C: Textbook of the Nervous System, Philadelphia, Lippincott Co., 300, 1947.
45. Ranson, S. A.: Anatomy of the Nervous System, 8th Ed., Philadelphia, Saunders Co., 1947.
46. Weil: Textbook of Neuropatholog)', Philadelphia, Lea and Febiger, 1933.
47. Cobb, S. : Preface to Nervous Disease, Baltimore, W. Wood & Co., 1936.
48. Le Gros: Practical Anatomy, London, Arnold & Co., 1946.
STUDIES IN THE TREATMENT OF TINEA CAPITIS. II
Butyl 1-butanethiolsulfinate (Win 717) *f
HARRY M. ROBINSON, M.D., HARRY M. ROBINSON, JR., M.D. and
HARWOOD V. LINK, M.D.
In the first study in this series (1) we presented the results of our clinical experience
in the treatment of tinea capitis with 5-nitro-2 furfuryl methyl ether (Furaspor), and
demonstrated that 42.47 per cent of the patients who used this drug in accordance
with the directions given, received a good result. It is our plan to continue to investi-
gate the therapeutic value of new preparations in the managements of microsporon
audouini infection of the hair. The preparation under consideration in this presenta-
tion is butyl 1-butanethiolsulfinate1 (Win 717) which is a synthetic analog al allyl
2-propene-l-thiolsulfinate, the antibacterial principle of allium sativum, the common
garlic.
NATURE OF DRUG
Win 7 1 7 is a pale yellow oily substance which is slightly soluble in water and very
soluble in most organic solvents. It is unstable in alkaline solutions and in the presence
of strong reducing agents, but is stable in dilute acid solutions. The chemistry of this
compound has been reported by Cavallito and his co-workers (2). Small, Bailey and
Cavallito (3) have shown that a maximum dilution of 1:833,000 of this preparation
will cause complete stasis of fungus growth. It was the opinion of these workers that
this substance has an extremely high activity against microsporon audouini and also
that it had the ability to penetrate the unbroken skin. They demonstrated in the
patients they tested by patch tests that a 1 : 2500 solution was non-irritating to the
skin.
CLINICAL STUDIES
The studies on this material were carried out in the Department of Dermatology
of the University of Maryland School of Medicine. A total of 103 patients were
started on treatment with this compound. Each child was proved to have tinea capitis
by examination under the Wood's light, and following this smears and cultures on
Saboraud's media were made. All cases treated with Win 717 were proved by culture
to be infected with microsporon audouini. There were 53 white children and 50 Negro
children in this study and the ages ranged from 2 to 14 years. Thirty-four of these
children received treatment for less than 1 month primarily because of a lack of co-
operation on the part of the parents who refused to bring them in to the clinic for
medication and observation. The method of treatment was changed on any patient
who did not show improvement after 6 months treatment with this drug.
* From the Department of Dermatology, University of Maryland School of Medicine,
t Received for publication May 2, 1950.
1 The Butyl 1-butanethiolsulfinate (Win 717) used in this study was furnished by Wintbrop-
Stearns, Inc.
16
ROBINSON, ROBINSON AND LINK— TINEA CAPITIS
17
METHOD OF TREATMENT
As soon as the diagnosis was established the parent or guardian was instructed to
shave the child's head once each week until the child was discharged as cured. Each
patient was furnished with a two ounce bottle of Win 717 and instructed to rub this
solution lightly into the scalp, with a toothbrush if possible, twice daily. In order to
comply with health department regulations the same routine was followed as in the
first section of this study, that is, the patient was instructed to wear a washable white
TABLE 1
AGE
GROUP
RACE
SEX
z
o
n
w
t*
« en
< z
H W
M a
as H
H <
z
RE-
CEIVED
LESS
THAN 1
MONTH
OF
TREAT-
MENT
Id
«
NUMBER
OF FAIL-
URES
AFTER 6
MONTHS
OF
TREAT-
MENT
IM-
PROVED
AFTER 6
MONTHS
OF
TREAT-
MENT
BUT
LOST
FROM
OBSER-
VATION
SHORTEST TIME
TO PRODUCE
IMPROVEMENT
LONGEST TIME
TO PRODUCE
CURE
SHORTEST TIME
TO PRODUCE
CURE
NUM-
BER OF
UNCO-
OPER-
ATIVE
PA-
TIENTS
1-5
c
M
F
21
1
9
0
2
0
5
1
1
0
1 mon.
12 mos.
8 mos.
10
w
M
F
10
9
1
2
7
3
1
1
4
0
7
2
6
1
0
3
1
0
1 mon.
1 mon.
9 mos.
9 mos.
4 mos.
1
2
6-10
C
M
F
21
6
3 mos.
13 mos.
8
3
VV
M
F
27
5
9
2
5
1
6
1
1
0
1 mon.
2 mos.
14 mos.
10 mos.
12 mos.
5
1
11-14
C
M
F
1
0
1
0
1
0
0
0
0
0
2 mos.
12 mos.
W
M
F
2
0
0
0
1
0
16
1
0
0
0
1 mon.
8 mos.
Totals
103
34
30
6
Average 1|
months
Average 10f
months
Average 8
months
31
cap at all times so that there would be no interference with his or her school work.
Each case was reported to the health department as an infectious disease. Parents
were instructed to wash the child's scalp with soap and water twice each week. Fol-
lowing the institution of treatment each child was examined under the Wood's light
at bi-weekly intervals to determine improvement.
RESULTS OF TREATMENT
Of the 103 patients with tinea capitis as a result of microsporon audouini who were
started on therapy with Win 717, 34 were treated for less than 1 month, and of these
20 did not return after the initial clinic visit. There were 16 cures and 30 failures after
18 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID.
6 months of therapy. Six patients showed some improvement after 6 months of ther-
apy but it was not considered sufficient to warrant continuation of the drug and,
therefore, the method of treatment was changed. The shortest times to produce a
cure was 4 months. The longest time to produce a cure was 14 months. The calcula-
tion of the percentage of cures based on the total number of patients was 15.5 per
cent; if, however, the number of patients who received less than 1 month of treat-
ment is deducted then 23.1 per cent of the patients treated were cured. No patient
was considered cured unless there was a complete absence of fluorescence under the
Wood's light for at least 2 months after therapy had been discontinued. Thirty-one
patients are listed as uncooperative and this may be explained on the basis of failing
to shave the child's head or to apply the solution regularly.
CONCLUSIONS
1. Butyl 1-butanethiolsuffinate (Win 717) has been used in the treatment of 103
patients with microsporon audouini infection of the hair.
2. Thirty-four of these patients who were treated with this drug received less than
1 month of therapy and 31 patients were uncooperative in attendance at the clinic
and the method of treatment carried out by the parents.
3. Of the total number treated, 15.5 per cent were cured; when the total number of
patients who received less than 1 month of treatment is deducted, the percentage of
cures is 23.1 per cent.
4. The percentage of cures obtained with this drug in the treatment of tinea capitis
in this clinic does not warrant its further use as a therapeutic agent in this disease.
REFERENCES
1. Robinson, H. M., Robinson, H. M., Jr. and Link, H. V.: Furaspor in the treatment of tinea
capitis. Bull. School of Med. U. of M., 35: (July) 1950.
2. Cavallito, C. J. and Bailey, J. H.: Allicin, the antibacterial principle of allium sativum. I.
Isolation, physical properties and antibacterial action. Jour. Am. Chem. Soc, 66: 1950, 1944.
3. Small, C. J., Bailey, J. H. and Buck, J. S.: The antibacterial principle of allium sativum. III.
Its precursor and "essential oil of garlic." Jour. Am. Chem. Soc, 67: 1032, 1945.
OSTEOGENIC SARCOMA ARISING IN PAGET'S DISEASE
(OSTEITIS DEFORMANS) OF THE CALVARIUM
Report or a Case Showing Cerebral Extension*
ROBERT C. RODGER, M.D.,f RAYMOND K. THOMPSON, M.D.,J
JOHN A. WAGNER, M.D.H
Osteosarcoma may be expected to arise in 5 to 10 per cent of the cases of Paget's
disease (osteitis deformans), especially in patients over 50 (1, 2, 3, 4). Summey and
Pressly (5), in 1946 listed 76 cases of osteogenic sarcoma complicating Paget's disease.
Of these 15 involved the calvarium. Since that time (26), additional cases (6, 7, 8, 9,
13, 14, 15, 16, 17) have been reported with two arising in the skull (7, 8). Cerebral
extension of an osteosarcoma arising in Paget's disease has been reported only 3
times (8, 10, 11). Two additional cases (7, 12) showed subdural extension without in-
vasion of the cerebral cortex. The following report represents the fourth case to show
cortical invasion.
REPORT OF A CASE
A 52-year-old colored male mechanic was admitted to the U. S. Marine Hospital, Baltimore, Md.,
one month after sustaining a blow to the right parieto-occipital region. This episode was followed by
headache, dizziness and the appearance of a mass at the site of injury. This mass gradually increased
in size. Roentgen examination of the skull on admission to the hospital revealed an underlying rounded
area of bone destruction in the right parieto-occipital region 2.5 cm. in diameter with a spongy ap-
pearance of the surrounding, thickened calvarium. There was also mottling of the pelvis, 4th lumbar
vertebral body, and left ulna. These findings were interpreted by the radiologist as suggesting Paget's
disease of bone with a superimposed "metastatic lesion" in the right parietal area (Fig. 1).
The physical examination disclosed a tender, fluctuant mass, 5x6 cm. in size, lying in the right
occipital region. Neurologic and funduscopic examinations revealed no abnormalities. The patient's
temperature, pulse and respirations were normal. An alkaline phosphatase was 44.5 Bodansky units,
blood calcium 11.4 mgm. per cent; acid phosphatase 0.66 unit, and blood phosphorus 4.02 mgm. per
cent. Serologic tests for syphilis were negative. Urinalysis and hematologic examinations showed no
significant abnormalities. Serum proteins were within normal limits. The cerebro-spinal fluid was not
examined. The scalp lesion was interpreted clinically as a hematoma. Surgical exploration revealed
an apparently encapsulated mass overlying an irregular defect in the calvarium. A biopsy of the
lesion was undertaken and the specimen was interpreted as showing Paget's disease (osteitis defor-
mans) with a superimposed osteolytic form of osteogenic sarcoma. Subsequent exploration of an
area of the ulna showed spongy thickening. This was interpreted microscopically as Paget's disease.
A block excision of the tumor, including the adjacent uninvolved calvarium was then performed.
The dura was incised around all except the vertex attachment of the falx, adjacent to the superior
saggital sinus. The tumor was then rolled out of its nest in the brain. A small fragment was found
attached to the superior parietal region of the cortex. This was removed and bleeding controlled with
an electrocautery. It was necessary to transect the tumor at the periphery so that complete excision
was not possible. A tantalum plate was used to fill the defect and skin grafting was subsequently
* From the Pathology Service and Tumor Clinic, U. S. Marine Hospital, Baltimore, Md. Received
for publication July 15, 1950.
f Senior Assistant Surgeon, USPHS; Resident in Pathology, U. S. Marine Hospital, Baltimore,
Md.
X Consultant in Neurologic Surgery, U. S. Marine Hospital, Baltimore, Md.
H Consultant in Neuropathology, U. S. Marine Hospital, Baltimore, Md.
19
20 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
undertaken. A microscopic examination confirmed the diagnosis of osteogenic sarcoma complicating
Paget's disease of the skull and showed neoplastic cells within the dura and leptomeninges.
Five months later a recurrent nodule was seen in the scalp. This was resistant to local roentgen
therapy totaling 2050 roentgen units. Nine amonths after operation the patient was readmitted to
the hospital with severe headache and, shortly thereafter, suffered a generalized convulsion which
began in the right hand. Following this attack he became stuporous. He continued to complain of
severe frontal headache, and gradually became more and more disoriented. A daily rise in temperature
to 100°F. with a terminal elevation to 102° was recorded. Objective neurologic findings were absent
and there was no evidence of weakness of the extremities. Terminally, he became comatose and died
nine and one-half months after the operation.
Fig. 1. Coronal section of brain just caudal to the splenium of the corpus callosum, showing
cortical invasion by tumor with extensive secondary hemorrhage.
Autopsy findings. An examination of the body generally showed only pulmonary congestion. The
contour of the cranium was irregular. A necrotic, ulcerating, fungating mass was seen at the vertex
and in the right parieto-occipital region. The scalp was firmly adherent to the thickened calvarium.
Large neoplastic masses involving the right parietal and occipital bones invaded the underlying dura
mater and falx cerebri. On dissection following fixation, the dural mass was seen to be invading the
cerebral cortex which it had infiltrated and destroyed at a point 5 cm. rostrad to the right occipital
pole and 2 cm. from the midline (Fig. 1). The greatest diameter of the invading nodule was 1 cm. It
was continuous with an extensive area of intracerebral hemorrhage extending through the right
centrum ovale, rostrad to the level of the cerebral peduncles. Here it involved the basal ganglia on
the right with intraventricular extension and displacement of the midline structures toward the left.
A microscopic examination of the calvarium revealed areas of trabecular thickening with fibrosis
of marrow spaces (fig. 3) alternating with areas of infiltration by pleomorphic, occasionally multinu-
cleated, neoplastic cells forming irregular osteoid deposits and, simultaneously, resulting in osteolysis
RODGER ET A L — OSTEOGENIC SARCOMA IN PAGET'S DISEASE 21
Fig. 2 (Top). Roentgenogram of skull showing mottled thickening of calvarium and punched-out
area in parietal region.
Fig. 3 (Bottom). Bone from skull showing thickened trabeculae and fibrous marrow of Paget's
disease. Van Gieson stain. X 170.
22
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
i ■'■■ r-~' ;?•-!';■ 'A'.'; -;v.7 ' ■. -
w
^
w
*'
Fig. 4 (Top). Osteogenic sarcoma in leptomeninges, right parietal lobe. Romanowsky stain. X
170.
Fig. 5 (Bottom). Osteogenic sarcoma invading cerebral cortex, right parietal lobe. Romanow-
sky stain. X 340.
RODGER ET A L— OSTEOGENIC SARCOMA IN PAGET'S DISEASE 23
of existing trabeculae. Neoplastic cells similar to those seen in the biopsy made up the dural masses
and the nodule infiltrating cortical tissue (figs. 4 and 5). A moderately intense zone of reactive glia
surrounded the invading cells. There was also a mild lobular pneumonia. Changes consistent with
Paget's disease were found in the left ulna and pelvis.
COMMENT
The report within 7 years of 6 cases of osteosarcoma arising in Paget's disease of
the skull and showing subdural extension, has led to the inclusion of a new entity of
increasing frequency among secondary intracranial neoplasms. These cases have
demonstrated that, following involvement of the inner table of the skull, the dura can
promptly be invaded and intracranial extension may occur, the arachnoidal mem-
branes constituting little or no barrier.
In this brief series, certain features have been repeated. Two of the cases have
shown an osteolytic form of sarcoma. Each has also shown secondary massive intra-
cerebral hemorrhage.
SUMMARY
A case of osteogenic sarcoma (osteolytic type), arising in Paget's disease (osteitis
deformans) of the calvarium, with intracerebral extension is presented and the litera-
ture reviewed. This case represents the sixth to show subdural extension and the
fourth to show cerebral involvement. Massive intracerebral hemorrhage was a ter-
minal feature of the process.
REFERENCES
1. Willis, R. A.: Pathology of Tumors. C. V. Mosby Co., St. Louis, Mo., 1948.
2. Geshickter, C. F. and Copeland, M. : Tumors of Bone. N. Y., 1936.
3. Bird, C. E.: Sarcoma complicating Paget's disease of bone. Arch. Surg., 14: 1187-1208 (June)
1927.
4. Kerr, J. W.: Osteitis deformans. Public Health Bulletin No. 209, U. S. Government Printing
Office (Sept.) 1933.
5. Summey, T. J. and Pressly, C. L. : Sarcoma complicating Paget's disease of bone. Ann. Surg.,
123: 135-154 (Jan.) 1946.
6. Platt, H.: Sarcoma in abnormal bones. Brit. J. Surg., 34: 232-239 (Jan.) 1947.
7. Warren, S. and Agar, D. F.: Paget's disease of the skull with osteogenic sarcoma (Tumor
Seminar). J. Mo. State M. Assoc, 45: 348-349 (May) 1948.
8. Russell, D. S.: Malignant osteoclasoma. J. Bone and Joint Surg. 31-B: 281-290 (May) 1949.
9. Sear, H. R.: Osteogenic sarcoma as a complication of osteitis deformans. Brit. J. Radiol., 22:
580-587 (Oct.) 1949.
10. Kirschbatjm, J. D.: Fibrosarcoma of the skull in Paget's disease. Arch. Path., 36: 74-79 (July)
1943.
11. Manganiello, L. O. J., Reimann, D. L. and Wagner, J. A.: Cerebral involvement by osteo-
genic sarcoma associated with Paget's disease of the skull. Arch. Neur. and Psych., 59: 99-106
(Jan.) 1948.
12. Wolfe, A. M. and Black, W. C: Paget's disease; report of case with intracranial neoplasm.
Rocky Mount. M. J., 37: 586-587 (Aug.) 1940.
13. Layani, F. and Olivier, C: Osteosarcoma and Paget's disease. Presse Med., 54: 145-146
(Mar. 1946).
14. Pique, J. A., Tamini, R. A. and Serebinsky, F.: Osteitis deformans, sarcomatous transforma-
tions. Bol. y trab. Soc. argent, de cirujanos, 7: 138-149 (1946).
15. Schajowicz and Alarcon, F. O.: Osteitis deformans, sarcomatous transformation. Rev. ortop.
y traumatol., 15: 233-246 (Apr.) 1946.
16. Betoulleres, P., Romien, C. and Guilbert, H. L.: La degenerescence maligni de la maladie
osseuse de Paget. Bull. Assoc, franc, l'etude cancer, 35: 47-64, 1948.
17. de Seze, S. and Lefebure: Sarcome et maladie de Paget; deux observations. Rev. du rhum., 14:
126-128 (Apr.) 1947.
PERICARDIAL COELOMIC CYSTS*
Review of the Literature and Report of a Case
WILLIAM RIENHOFF, Jr., M.D. F.A.C.S., ROBERT L. JACKSON, M.D. F.A.C.S.
and MARCUS W. MOORE, Sr., M.D.
Baltimore, Maryland
Six cases of Coelomic Cysts of the Pericardium were reported by Lambert (1) in
1940, in which 2 anterior pericardial cysts were removed by Berry. Blades later re-
classified 5 cases of anterior mediastinal tumors as Coelomic Pericardial Cysts. In
1947, Leahy and Culver (2) reviewed the literature of cases of pericardial cysts.
Bradford, Mahon, and Grow (3), in the same year reported a series of 8 cases. Other
case reports have been made by Lam (4), Leahy and Culver (2), and Buyers and
Emery (5).
Thompson (6) states that according to the suggestion of Freedlander and Gebauer
(7), the pericardial defects might be produced by failure of fusion of embryonic trans-
verse septum with the pleuro-pericardial or pleuro-peritoneal membranes. However,
Lambert (1) attributes the origin of pericardial cysts to failure of primitive mesen-
chymal lacunae, which form the pericardium, to fuse with others, and instead to
form independent cavities. He describes these cysts as being lined by vascular en-
dothelial cells upon a loose fibrous tissue containing capillaries and noted that it
was difficult to distinguish between mesothelial and endothelial linings.
Coelomic pericardial cysts have no distinct characteristic features which differen-
tiate them from other mediastinal cysts (6). Coelomic pericardial cysts usually give
a rounded defined translucent mass roentgenologically. Buyers and Emery (5) states
that the diagnosis is made only from gross and pathologic findings.
Mediastinal cysts in former years were felt to be rare in occurrence. However,
with recent advances in thoracic surgery, many of these cysts have been success-
fully removed. In 1945 Laipply (8) gave an extensive review of mediastinal cysts
and classified them according to their histologic structure.
case report
H. J., a Negro male, 44 years of age was admitted to Provident Hospital on September 6, 1949.
The patient had been asymptomatic but the presence of an anterior mediastinal tumor was dis-
covered in May 1949 during a routine public health chest roentgenologic examination. There was
no history of chest pains, hemoptysis, shortness of breath, or palpitation. There had been no weight
loss, fever, or wheezing.
The patient was a slender male, in no acute distress, lying flat in bed, cooperative and well-
oriented. His temperature was 98 F.; his pulse rate was 80 per minute; his respiratory rate was 20
per minute; and his blood pressure was 120 mm. Hg systolic and 80 mm. Hg diastolic. The only
abnormal physical finding was an area of increased dullness over the apex of the heart that extended
from the left parasternal line to the left anterior axillary line.
Roentgenographs revealed a small tumor at the apex of the heart in the left anterior mediastinum
* From the Surgical Service of Dr. Samuel McLanahan, Provident Hospital. Baltimore, Mary-
land.
Received for publication September 1, 1950.
24
RIENHOFF ET AL— PERICARDIAL COELOMIC CYSTS
25
Fig. 1 Fig. 2
Fig. 1 . A preoperative roentgenograph showing a translucent tumor of the left cardiophrenic angle
Fig. 2. A postoperative roentgenograph showing that the pericardial coelomic cyst was. removed
DtAPHRAGM'
Fig. 3. A large unilocular thin walled pericardial cyst was found at operation
26 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
(Figure 1). This tumor was ovoid, smooth, circumscribed, and translucent. It measured 8x7x5
cm. Fluoroscopy revealed no pulsation in the tumor. It was found to spring from the pericardium
and not to be connected to the heart. Its base was on the left leaf of the diaphragm. The motility
of the diaphragm was normal. The hemoglobin was 94 per cent and the leukocytes numbered 1 1 ,000
per cubic millimeter. The erythrocytes count was 4,730,000 per cubic millimeter. The blood Was-
sermann test for syphilis was negative. The urinalysis and electrocardiagraph were normal.
In May, 1949 an exploratory thoracotomy was advised, to which he consented in September
1949. Serial roentgenographs between the 4 month period revealed no change in the size or position
of the tumor.
The operation was performed September 8, 1949, under intratracheal nitrous oxide and oxygen
and intravenous sodium pentothal and curare. A left anterio-lateral incision was made in the eighth
intercostal space 18 cm. long, and the ribs were forcibly retracted with a rib spreader. The left lung
was retracted laterally. A large unilocular thin walled cyst was found in the anterior mediastinum.
It measured 10 x 12 x 6 cm. The phrenic nerve was overlying the lateral border of the cyst (Fig-
ure 3).
The cyst was enulceated by blunt dissection. Hemorrhage was slight and easily controlled. The
phrenic nerve was not divided. Closure was effected with interrupted number 2 chromic catgut
sutures. The post-operative condition of the patient was excellent. Temperature, pulse, and respir-
atory rates were normal throughout the entire post-operative course. The skin sutures were re-
moved and the patient was discharged in excellent condition on the seventh post-operative day.
Recent roentgenographs revealed a good expansion of the lungs with no evidence of recurrence of
the cyst (Figure 2). To date he has remained in excellent health.
Pathologic Examination
The specimen consisted of a whitish smooth walled unilocular cyst with a clear watery fluid, having
a specific gravity of 1,001. It measured 10 x 12 x 6 cm. The wall was thin and translucent. The
inner surface was smooth, glistening and traversed by thread-line blood vessels.
Microscopically the cyst wall consisted of a single layer of flattened mesothelial type cells on a
thin layer of vascularized loose connective tissue. The pathologic diagnosis was pericardial coelomic
cyst.
DISCUSSION
Following the classifications derived by Laipply (8) and by Donald (9) this cyst
was identified as a pericardial coelomic cyst. It had the gross appearance of the
smooth thin walled translucent pericardial cyst and had the pathologic evidence of
a single layer of mesothelial cells on a thin connective tissue stroma. The cyst found
in this case report could be differentiated from other congenital mediastinal cysts.
The gastroenteric cyst was ruled out by the absence of smooth muscle fibers, mucous
glands and columnar epithelium. In the dermoid and teratoid cysts, hair, bone, skin
and cartilage can usually be identified. Also, the congenital bronchial cyst could be
ruled out by the absence of walls with smooth muscle, mucus glands, cartilage and
ciliated epithelium.
SUMMARY
A case of coelomic cyst of the pericardium discovered during a mass roentgenologic
survey is reported. Surgical excision of the cyst was successful with no recurrence.
REFERENCES
1. Lambert, A. V. S.: Etiology of thin walled thoracic cysts, J. Thoracic Surg. 10: 1, 1940.
2. Leahy, L. J., and Culver, G. J.: Pericardial coelomic cysts, J. Thoracic Surg. 16: 695, 1947.
RIENHOFF ET AL— PERICARDIAL COELOMIC CYSTS 27
3. Bradford, M. L., Mahon, H. W., and Grow, J. B.: Mediastinal cysts and tumors, Surg., Gynec.
& Obst. 85: 470, 1947.
4. Lam, C. R.: Pericardial coelomic cysts, Radiology 48: 239, 1947. •
5. Byers, R. A., and Emery, F. B.: Pericardial coelomic cysts, Arch. Surg. 60: 1002, 1950.
6. Thompson, J. V.: Mediastinal tumors and cysts, Internat. Abstr. Surg. 84: 211, 1947.
7. Freedlander, S. O., and Gebauer, P. W. : Diseases of aberrant intrathoracic lung tissue, J.
Thoracic Surg. 8: 581, 1939.
8. Laipply, T. C: Cysts and cystic tumors of the mediastinum, Arch. Path. 39: 153, 1945.
9. Donald, C. J., Jr.: Mediastinal cysts, South. Surgeon 13: 148, 1947.
DEPARTMENT OF OBSTETRICS
Statistical Summary
July 1, 1949 through June 30, 1950
1. Number of patients discharged
2. Number of patients delivered and discharged
(twins 33 sets)
a. Patients delivered of viable infants
b. Patients aborting
3. Maternal mortality
a. Rate per 1000 live births
4. Number of viable babbies born (400 gms.
and over)
a. Term
b. Premature*
A. Number born alive
a. Term
b. Premature
B. Number still born
a. Term
b. Premature
c. Rate per 1000 viable births
5. Number of neonatal deaths
a. Term
b. Premature
c. Rate per 1000 viable births
6. Total fetal mortality
a. Rate per 1000 births
TOTAL
HOME
HOSPITAL SERVICE
Wh.
Col.
Wh.
Col.
3586
11
490
523
1565
3292
11
490
474
1413
3241
11
486
469
1399
51
0
4
5
14
1
0
0
0
1
0.3C
0
0
0
0.71
3274
11
490
474
1419
2906
10
446
424
1208
368
1
44
50
211
3201
11
479
468
1381
2872
10
441
421
1193
329
1
38
47
188
73
0
11
6
38
34
0
5
3
15
39
0
6
3
23
22.3
00.0
22.4
12.7
26.8
50
1
10
6
25
19
1
4
1
8
31
0
6
5
17
15.2
90.9
20.4
12.7
17.6
123
1
21
12
63
37.5
90.9
42.8
25.4
44.4
997
904
876
28
0
0
818
62
862
807
55
18
11
7
20.4
8
5
3
9.1
26
29.5
A premature baby is one which weighs less than 2500 gms. at birth.
Patient Status
Private patients (twins 4 sets)
White — registered clinic (twins 5 sets) ....
White — nonregislered clinic (twins 0 sets)
Colored — registered (twins 18 sets)
Colored — nonregistered (twins 6 sets) ....
LIVE BIRTHS STILLBIRTHS ABORTION
862
392
87
1668
192
18
2
4
31
18
28
2
3
8
10
908
396
94
1707
220
3291
73
51
3325
Presentation: Premature and Full Term (Delivery Diagnosis)
SPON.
DEL.
SPOX.
DEL.
OPERATION
OPERATION'
TOTAL
HOME
HOSP.
FROM BELOW
FROM ABOVE
Wh.
Col.
Wh.
Col.
Wh.
Col.
Wh.
Cot.
Wh.
Col.
Vertex
10
480
276
606
980
664
32
64
1298
1814
Face
0
0
0
2
4
2
1
0
5
4
Brow
0
0
0
0
0
1
0
1
0
2
Breech
1
8
3
10
46
47
8
4
58
69
Transverse
0
0
0
1
1
4
2
4
3
9
Compound
0
2
0
2
2
4
0
0
2
8
Unknown
0
0
0
3
0
0
0
0
0
3
1366
1909
28
DEPARTMENT OF OBSTETRICS— A NN I AL REPORT
29
Types of Delivery
1. Spontaneous.
2. Operative . . .
H
Forceps — total . .
Indications
Control
Presentation occiput posterior.
Delivered as such
Following forceps rotation. . .
Following manual rotation. . .
Presentation occiput transverse .
Following forceps rotation . . .
Following manual rotation. . .
As such
Presentation, face
Labor, prolonged
Heart disease . .
Cord — prolapse of
Contracted pelvis
Fetal distress
Brow
Compound
Toxemia
Inertia
-total .
1542
1264
94
26
49
19
99
61
37
1
4
57
6
1
13
0
1
3
0
0
116
13
29
2
25
2
37
34
3
0
2
22
0
1
7
1
0
0
2
2
total
Breech extraction
Frank breech
a. Decomposed
Full breech
Primigravida
Multigravida
Head-Af tercoming-f orceps to
C. Version — internal podalic and breech extraction
Indications
Presentation transverse
Second twin
D. Craniotomy
E. Other Destructive operations — total
Indications and types transverse lie, decapitation. . .
F. Laparotomy (other than cesarean section) — total. . .
Indications and type exploratory, — volvulus, cecum.
G. Cesearean section — all types — total
Wh.
165
320
286
216
19
6
11
2
22
14
8
0
2
21
4
0
1
0
0
1
0
0
21
13
3
8
7
14
17
0
0
0
0
1
1
1
1
12
Col.
1103
806
671
511
47
13
23
11
46
31
15
0
2
46
0
2
9
1
1
2
2
2
60
30
2
30
32
28
21
4
3
1
0
0
0
0
0
71
124
756
701
550
57
9
40
50
17
1
2
12
2
0
10
0
0
0
0
0
24
15
2
9
9
15
0
0
0
0
0
0
0
30
1392
1882
1658
1277
123
28
64
21
136
95
40
1
6
79
6
1
20
1
1
3
2
2
105
58
7
47
48
57
46
4
3
1
0
1
1
1
1
114
42.7
57.3
50.6
3.2
0.1
30
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Type of Delivery — Continued
Indications
1 . Pelvis contracted.
2. Baby — excessive
size of
3. Inertia uterine . . .
4. Malpresentation . .
5. Placenta previa. . .
Centralis
Partialis
Marginalis
6. Placenta — prema-
ture separation of
Complete
Partial
7. Preeclampsia
8. Eclampsia
9. Section previous. .
a. Toxemia
b. Malpresenta-
tation
c. Plac. compl. . . .
d. Unknown
10. Presentation
breech
11. Rh incompata-
bility
12. Prolapse cord
13. Medical disease. . .
14. Diabetes
CLASS
LAPARO
TRACH
EXTRA
PERITO.
P.M.
CESAR.
CESAR.
HYSTER.
SERVICE
PVT.
TOTAL
Wh.
Col.
4
84
23
1
2
12
71
31
114
0
45
15
1
0
5
45
11
61
0
0
1
0
0
0
1
0
1
0
5
3
0
0
0
6
2
8
0
1
0
0
2
0
2
1
3
1
7
0
0
0
1
2
5
8
1
3
0
0
0
0
0
4
4
0
3
o
0
0
1
2
0
3
0
1
0
0
0
0
0
1
1
2
3
0
0
0
0
2
3
5
2
1
0
0
0
0
1
2
3
0
2
0
0
0
0
1
1
2
0
3
3
0
0
2
4
0
6
0
1
0
0
0
0
1
0
1
1
11
0
0
0
0
4
8
12
0
3
0
0
0
0
2
1
3
1
3
0
0
0
0
0
4
4
0
1
0
0
0
0
0
1
1
0
4
0
0
0
0
2
2
4
0
1
0
0
0
0
1
0
1
0
3
0
0
0
3
0
0
3
0
1
0
0
0
0
1
0
1
0
0
1
0
0
0
1
0
1
0
3
0
0
0
1
1
1
3
53.5
7.0
7.0
4.5
6.1
10.5
9
DEPARTMENT OF OBSTETRICS— ANNUAL REPORT
31
Other Operations and Procedures not Including Delivery
1. Episiotomy — total
a. Central
With rectal laceration
b. Paramedian
with rectal laceration
2. Perineorrhaphy — total
a. Indicated (laceration)
b. Elective (old R.V.O.) . .
3. Trachelorrhaphy
4. Hysterostomatomy — total
a. Dystocia cervical: forecoming head
5 . Hysterectomy — total
a. For sterilization only
b. Infection
6. Dilatation and curettage— total
a. Secundines retained
b. Mole, hydatidiform
c. Not pregnant
7. Placenta, manual removal of — total
8. Hematoma, evacuation of
9. Fetal scalp clamp — application of — total . .
a. Placenta — premature separation of ... .
b. Inertia uterine
c. Toxemia
d. Other .-,.-..
10. Amniorrhexis for induction of labor — total.
a. Preeclampsia
b. Hypertensive disease
c. Hydramnios
d. Placenta — -premature separation of ... .
e. Convenience
11. Sterilization
a. Section previous
b. Multiparity (para 8 or more)
c. Hypertensive disease
d. Diabetes
e. Pathology cardiac
f . Psychiatric
g. Sickle cell anemia
h. Other
Accompanying Section
12. Replacement of cord
13. Appendicectomy
14. Other gyn. operations
15. Other operations
SERVICE
PVT.
TOTAL
Wh.
Col.
287
732
765
1784
283
708
721
1712
14
22
39
75
4
24
44
72
0
0
0
0
49
136
61
246
33
101
53
187
16
35
8
59
8
32
29
67
0
5
4
9
0
5
4
9
0
3
0
3
0
2
0
2
0
1
0
1
3
1
14
18
1
1
14
16
1
0
0
1
1
0
1
1
10
10
30
50
0
1
1
2
4
12
3
19
2
0
3
5
1
8
0
9
0
2
0
2
1
2
0
3
5
14
16
35
3
11
4
18
0
0
1
1
0
0
1
1
1
2
3
6
1
1
7
9
13
77
7
97
0
10
4
14
5
55
0
60
2
7
1
10
1
0
0
1
2
2
0
4
3
2
0
5
0
1
0
1
0
0
2
2
1
8
3
12
0
1
0
1
8
17
0
25
0
2
1
3
0
1
3
4
%
54.5
2.3
1.5
1.1
2.9
32
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Other Operations and Procedures not Including Delivery — Continued
ABORTIONS— Total
Therapeutic — total
a. Rupture, marginal sinus
b. Preeclampsia
Spontaneous — total
a. Syphilis-maternal
b. Hypothyroidism
c. Etiology undetermined
Requiring completion
SERVICE
Wh.
Col.
PVT.
TOTAL
5
18
28
51
0
1
1
2
0
1
0
1
0
0
1
1
5
17
27
49
0
1
0
1
0
0
1
1
5
16
26
47
1
1
14
16
Complications
Maternal
Placental — total
Placenta previa centralis
Placenta previa partialis
Placenta previa marginalis
Placenta, premature separation of
Placenta retained
Cord, prolapse of
Pelvis contraction of (X-ray classification)
Contracted inlet
Contracted midplane
Contracted outlet
Contracted inlet and outlet
Contracted inlet and midplane
Contracted midplane and outlet
Contracted inlet, mp and outlet
Contracted asymmetrical
Labor
Prolonged
Shock antepartum
Intrapartum
Postpartum
Uterus — inertia of
Rupture of
Inversion of
Membranes — rupture of — premature . . .
Dystocia — cervical
Hemorrhage and blood dyscrasia
Anemia
Wh.
361
22
0
1
0
7
12
2
21
4
5
2
0
5
4
1
0
45
8
1
1
15
8
0
1
11
0
154
42
Col.
1568
60
1
3
1
29
18
8
154
58
11
7
6
38
14
19
1
216
74
0
6
27
32
1
1
72
3
565
369
PVT.
TOTAL
610
2539
62
144
5
6
0
4
0
1
25
61
30
60
2
12
41
216
9
71
14
30
3
12
0
6
2
45
9
27
4
24
0
1
86
347
27
109
0
1
5
12
9
51
17
57
0
1
0
2
26
109
2
5
221
940
23
434
DEPARTMENT OF OBSTETRICS— ANNUAL REPORT
33
Complications — Continued
Maternal — Continued
Hemorrhage and blood dyscrasia — Continued
Sickle cell anemia
Hemorrhage antepartum
Intrapartum
Postpartum
Rh negative — total
With antibodies
Other iso immunization
Cardiovascular disease
Toxemia
Hypertensive disease
Preeclampsia
Eclampsia
Unclassified
Infection
Genital tract
Puerperal
Wound — perineal
Intrapartum infection
Respiratory
Tuberculosis active
Tuberculosis arrested
Respiratory disease, other
Urinary tract
Pyelitis — antepartum
Pyelitis — postpartum
Infection miscellaneous
Thrombophlebitis
Appendicitis.
Hydxamnios
Mole hydatidiform
Diabetes
Shoulder dystocia
Hypothyroidism
Hyperthyroidism
Hyperemesis
Epilepsy
Rectum — stricture of
Ovarian Cyst
Fibroids
Fetal
Injury and disease
Hemorrhage intracranial
Atelectasis
SERVICE
pvr.
TOTAL
Wh.
Col.
0
3
0
3
4
8
9
21
7
29
25
61
24
45
14
83
76
110
150
336
11
13
5
29
1
1
0
2
12
31
12
55
50
297
56
403
17
92
20
129
32
199
35
266
1
5
0
6
0
42
1
172
1
72
2
286
19
112
27
158
14
75
23
112
3
4
2
9
2
33
2
37
12
26
23
61
3
10
3
16
2
6
3
11
7
10
17
34
10
33
22
65
6
21
14
41
4
12
8
24
1
1
0
2
0
1
0
1
1
0
0
1
6
30
2
38
1
0
1
2
4
7
6
17
3
9
3
15
0
4
18
22
0
4
2
6
0
1
8
9
0
1
0
1
0
6
1
7
. 1
1
2
4
0
10
17
27
61
174
90
325
20
44
26
90
4
10
5
19
8
24
16
48
34
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Complications — Continued
Fetal — Continued
Injury and disease — Continued
Newborn — hemolytic disease of
Other injury
Infection
Diarrhea
Conjunctiva's
Impetigo
Pneumonia
Omphalitis
Septicemia
Syphilis
Development — abnormalities of. .
CNS
Heart
Gastrointestinal
Extremities
Mouth
Other
Hemorrhagic disease
CNS anoxia
Tumors
Others
SERVICE
PVT.
TOTAL
Wh.
Col.
6
5
2
13
2
5
3
10
14
49
20
83
0
5
2
7
2
10
3
15
8
9
10
27
1
8
4
13
1
4
1
6
2
1
0
3
0
12
0
12
25
70
31
126
5
6
4
15
2
4
5
11
3
5
7
15
8
27
11
46
2
6
1
9
5
22
3
30
2
5
4
11
0
5
1
6
0
1
3
4
0
0
5
5
Total Number of Viable Babies (Twins — 33 Sets)
Born Alive 3201
HOME DELIVERY
HOSPITAL DELIVERY
TOTAL
Wh.
Col.
Service
Private
L.
1
21
47
229
298
90.6
D.
2
12
12
5
31
Wh.
Col.
L.
0
4
4
44
52
D.
0
0
2
1
3
a
L.
0
0
0
1
1
D
0
0
0
0
0
L.
0
3
4
25
32
D.
0
4
1
1
6
L.
0
0
6
36
42
D.
1
0
3
1
5
L.
1
14
33
123
171
D.
1
8
6
2
17
5§
Birth weight — less than 1000 gms
1000 to 1499 gms
1500 to 1999
2000 to 2499
67
36
20
9
All premature live briths
Salvage
9.4
Term live births (2500 plus gms.)
9
1
437
4
420
1
1185
8
802
5
2853
19
DEPARTMENT OF OBSTETRICS— ANNUAL REPORT
35
Premature Labor — Causes of
Induced
Toxemia
Preeclampsia
Hypertensive disease
Hemorrhage
Placenta previa
Placenta — premature separation of
Diabetes
Hydramnios
Elective
Spontaneous
Toxemia
Preeclampsia
Hypertensive disease
Hemorrhage
Placenta previa
Placenta — premature separation of
Other hemorrhages
Membranes — premature rupture of. .
Syphilis
Hydramnios
Pregnancy multiple
Disease — maternal — acute infectious
Pathology — cervical
Fetus — abnormalities of
Fetus — intrauterine death of
Maternal disease
Cause undetermined
HOME DELIVERY
HOSPITAL DELIVERY
Service
Wh.
Col.
Private
Wh.
Col.
0
0
3
14
7
0
0
3
10
3
0
0
2
9
3
0
0
1
1
0
0
0
0
4
1
0
0
0
1
1
0
0
0
3
0
0
0
0
0
1
0
0
0
0
1
0
0
0
0
1
1
44
47
197
55
0
6
3
34
3
0
0
2
22
3
0
6
1
12
0
0
2
3
14
9
0
1
0
1
0
0
1
2
9
8
0
0
1
4
1
0
5
2
19
14
0
4
2
16
0
0
0
1
3
0
0
6
7
13
4
0
0
0
3
0
0
0
0
4
0
0
0
2
7
2
0
0
0
6
3
0
0
0
2
0
1
21
27
76
20
24
16
14
2
5
2
3
1
1
1
344
46
27
19
28
2
20
6
40
22
4
30
3
4
11
9
2
145
Etiology of Neonatal Mortality (Stillbirths and Deaths in Live Born)
Hemorrhage intracranial
Disproportion cephalopelvic
Delivery vertex-traumatic . .
Delivery breech
Unknown
Precipitate labor
PREMATURE
Home delivery
Hospital delivery
Wh.
Col.
0
Sen
Wh.
/ice
Col.
Pri-
vate
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
1
0
0
0
0
0
0
FULL TERM
Home delivery
Wh.
Col.
Hospital delivery
Service
Wh.
Col.
Pri-
vate
11
5
1
4
0
1
36
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID.
Etiology of Neonatal Mortality (Stillbirths and Deaths in Live Born) — Continued
Anoxemia
Placenta — premature separation
of
Placenta previa
Toxemia
Cord-umbilical compression of . .
Complications — medical
Diabetes
Undetermined
Development — anomalies of
Infections
Syphilis
Pneumonia
Prematurity
Disease — hemolytic — congenital .
Diabetes
Undetermined
PREMATURE
Home delivery
Wh.
Col.
12
1
1
2
0
0
0
8
0
0
0
0
0
0
0
0
Hospital delivery
Service
Wh. Col
15
9
1
5
0
0
0
0
3
7
5
2
8
0
0
6
Pri-
vate
FULL TERM
Home delivery
Wh.
Col.
Hospital delivery
Service
Wh. Col
Pri-
vate
Maternal Morbidity*
HOME DELIVERY
Wh.
0
0
0
0
0
Rate
0
0
0
0
0
Col.
13
10
10
0
0
Rate
2.6
2.0
2.0
0
0
All causes
Birth canal only
Delivery spontaneous
Delivery operative below
Delivery operative above
HOSPITAL SERVICE
Wh. Rate Col. Rate
1()
17
2
13
2
5.5
3.6
1.2
4.2
16.7
95
65
21
26
18
6.7
4.6
3.4
3.5
25.4
PRIVATE
TOTAL
No.
Rate
4.1
No.
Rate
37
171
5.2
25
2.7
117
3.5
0
0.0
2>2>
2.4
22
3.0
61
3.4
3
10.0
23
20.0
*The criterion used for maternal morbidity is the standard of a temperature elevation to 100.4
degrees or over on any two days of the puerperium excluding the day of delivery.
Adult Deaths
Non-maternal mortality. ......
Maternal morality
Registered clinic patients. . . .
Non-registered clinic patients
Private patients
WH.
COL.
0
0
0
1
0
1
0
0
0
0
DEPARTMENT OF OBSTETRICS— ANNUAL REPORT
Mortality Rate per 1000 Live Births
37
TOTAL
RATE
WT.
RATE
0
COL.
RATE
Registered clinic
1
0
0
1
0.5
0.3
0
0
0
0
1
0
0
1
0.7
Non-registered clinic
Combined
0.7
Causes of Adult Deaths
1. Spinal Anesthesia
Maternal Death:
A 16 year old, colored, registered, Rh positive, STS negative, para 0000 was admitted at 6 P.M
on December 8, 1949 in active labor with membranes ruptured. On admission the cervix was 4-5
cm. dilated and 1 cm above the ischial spines. The prenatal course revealed a contracted inlet. At
9:00 P.M. the cervix was 6 cm. dilated and on sterile pelvic examination the fetal head was 2 cm.
above the ischial spines with molding and caput. A caesarean section was decided upon. At 9:18
P.M. a spinal anesthesia with- 10 mgm. pontocaine in 10 per cent glucose and 25 mgm. ephedrine was
given. A puncture was made at the third interspace, the patient tilted 10 degrees for 20 seconds and
then placed level. Her blood pressure was 116 systolic over 70 diastolic. The anesthesia level was
T-6. Her blood pressure was rechecked immediately and not obtained. Oxygen by positive pres-
sure was started and patient intubated. She was given whole blood intravenously and adrenalin
was injected into the heart. The patient died at 9:33 P.M. A post mortem section was successful.
Post mortem examination — Gross pathology-
congestion and petechial cerebral hemorrhages.
-nothing unusual. Microscopic — Slight cerebral
CLINICO-PATHOLOGIC CONFERENCE
From the Case Histories, University Hospital, Baltimore
Clinical History
A 55 year old white female was admitted to the medical service for diagnostic
study because of "colitis" and palpitation of the heart. In March, 1950 she began
to have diarrhea and cramping pains in her lower abdomen for which she was given
sulfasuxidine. After some improvement there was a return of nausea, diarrhea and
abdominal discomfort. Her abdomen became distended because of flatus. There was
no vomiting. She had numerous loose mucoid stools each day.
A history of fatigability and weight loss, later followed by palpitation, shortness
of breath and orthopnea was evident. The family history was not significant. Her
mother died of cerebral hemorrhage. The past history included two surgical opera-
tions, an appendectomy and right salpingo-oophorectomy thirty years previously.
Twelve years previously she had a cholecystectomy.
An examination on admission revealed a temperature of 98.6 F.; pulse, 84; respi-
rations, 20; blood pressure, 150 systolic over 80 diastolic. The patient was a well de-
veloped, obese white female complaining of palpitation and fatigue after walking
around the bed. The trachea was in the midline. The thyroid gland was normal.
There was no venous engorgement or cervical adenopathy. The breasts were large,
pendulous and free of palpable masses. The note elicited by percussion over the lungs
was resonant. The breath sounds were vesicular. There were no rales. The heart was
of normal size. No murmurs were heard. There was a healed upper right rectus ab-
dominal scar. There were no abdominal masses or tenderness. Borborygmus was
present. There was no cyanosis of the extremities. Varicosities were present in the
right leg. Pitting edema existed in both feet. The deep tendon reflexes were normal.
The white blood cells numbered 7,800 per cubic millimeter, of which 54 per cent
were neutrophilic polymorphonuclear granulocytes; 41 per cent, lymphocytes; 1 per
cent, monocytes; and 4 per cent eosinophilic polymorphonuclear granulocytes. Blood
platelets were normal. The blood urea nitrogen was determined to be 9 milligrams
per hundred cubic centimeters. The blood sugar concentration was 80 milligrams
per hundred cubic centimeters. A serologic test for syphilis was negative. Inversion
of T waves was noted on the electrocardiogram. There were no demonstrable para-
sites in the stools. Roentgenographs of the chest, skull, and upper gastro-intestinal
tract were insignificant. The barium enema (Fig. 1), was helpful in making the
diagnosis.
On June 12 a section of bowel was removed. Post-operatively the patient did well
and was allowed up on the day after operation. However, on the 14th of June her
temperature rose to 100.6 F. and pulse rate, to 100 per minute. An examination at
this time revealed fine rales in both bases. On the 19th of June a superficial phlebitis
developed in the dorsal vein of the right foot. The patient was given dicumarol and
aureomycin. The prothrombin time was maintained at 45 to 55 per cent. The tem-
perature and phlebitis gradually subsided. She was discharged on July 3, 1950.
38
CLINICO-PA THOLOGIC CONFERENCE
39
£5
a o .2
n 4> >-
« ° o
3 ° ««
+-> cd 3
8 * .1
t3 -d
bo 43
fe rC
pq
S §
E 3
p CO
o
40 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Clinical Discussion
Dr. T. R. Adams: So far as I am concerned, this case is an almost insoluble conun-
drum. There is surprisingly little information that would lead me to a diagnosis.
However, there are several things that should be considered in trying to make a diag-
nosis in this patient. I am going to assume that she had her trouble mainly in the
colon. There are many things that could cause the signs and symptoms in this pa-
tient. Some are uncommon and some quite rare. First, hyperplastic tuberculosis of
the colon, although deserving of consideration, would not permit the degree of health
and adiposity seen in this woman. Another possibility is polyposis of the colon. A
polyp could, without actual bleeding, cause the mucous colitis that she supposedly
had. A polyp could cause cramps and abdominal distension, either by its mass alone
or by its precipitating the formation of an intussusception. Another possibility,
syphilis, is discarded because of the negative serology. In chronic ulcerative colitis,
there are often bloody, mucinous stools, there is, however, a possibility of a seg-
mental type of colitis. We have all seen malignant tumors of the ovaries, uterine
body, and cervix involving the colon. That could cause the syndrome seen in this
patient. Her genital history is negative except for the removal of a tube and ovary
many years ago. Endometriosis should be considered in this case. This woman had
a hemoglobin of 95 per cent. She had not lost much weight. Endometriosis could
very well cause almost complete obstruction. Infrequently, one sees submucous
lipomata of the colon, which could give this clinical course. It could cause the par-
tial obstruction and mucous diarrhea. Intermittent volvulus of the sigmoid colon
might be added to this differential study. Mesenteric vascular occlusion, although
it is not very common, could cause an illness such as this patient experienced. Ad-
hesions causing partial obstruction may block the large bowel, but I do not recall
seeing it. Something else that comes to mind is a carcinoma of the stomach with
implants in the pelvis that might impinge upon the bowel. In the absence of symp-
toms of gastric disease, this possibility is excluded. Post irradiation strictures of the
colon are not indicated by this patient's history.
The best supposition in considering this case is a diverticulitis. This woman had
a normal hemoglobin, she had lost little or no weight, and she had symptoms of par-
tial obstruction. Diverticulitis should certainly be strongly suggested when one re-
members that 5 per cent of all persons over the age of 40 have diverticulosis. Only
about 8 to 10 per cent of that group suffer inflammatory complications. I am sur-
prised that this patient was not sigmoidoscoped.
Dr. D. J. Bar net t: The interest in this case, of course, is in the barium enema.
The preliminary examination of the abdomen showed no evidence of intestinal ob-
struction. On starting the enema, the barium suspension flowed very easily through
the entire colon. The distal half of the colon appeared distended. No peristaltic
activity was manifested in the right half of the colon (Fig. 1). At the junction of the
cecum, a filling lesion was demonstrated on the film made in a directly anterior-
posterior position. It demonstrated the lesion to lie in the midline. We know the
lesion was posterior and that it had a relatively smooth outline and indistinct lobu-
lations (Fig. 2). The barium suspension could not be forced into the ileum. After
evacuation, the filling defect was still visible at the junction of the ileum and colon.
CLINICO-PATHOLOGIC CONFERENCE 41
A relatively normal mucosal pattern was seen on the proximal half, but on the dis-
tal half the mucosa was in parallel bands and relatively flattened (Fig. 3). These
shadows were interpreted as indicative of malignancy or an old inflammatory proc-
ess of the cecal wall.
Dr. Adams: This looks to me like late ulcerative colitis with scarring. As I suggested
in the beginning, one certainly would have seen that with the aid of the sigmoido-
scope. If this is a carcinoma of the cecum, it certainly has not caused symptoms that
one usually sees in carcinomas involving the right half of the colon. One usually
finds that the hemoglobin is much lower than would be expected after finding little
blood in the stools. She had a hemoglobin concentration of 95 per cent even after
being ill for 3 or 4 months. Off-hand, one would not think that this was a carcinoma
of the cecum. The roentgenograph wouldn't appear thus if it had been carcinoma.
Extensive ulcerative colitis is my diagnosis.
Dr. H. C. Hull: I am not sure of what she had, but I make the hazardous diag-
nosis of submucous lipoma. At any rate, I think the lesion is a benign tumor.
Dr. H. R. Spencer: On what basis do you explain the lack of bleeding?
Dr. Hull: There was ho erosion of the mucous membranes.
Dr. R. C. Sheppard: I would like to ask Dr. Adams what he thinks of "carcinoid"
as the diagnosis?
Dr. Adams: The reason I did not mention it in the diagnosis was because I was
so sure that the lesion in this case was on the left half of the colon. Carcinoid tumors
are sometimes malignant, but very slow growing lesions that only occasionally
metastasize.
Dr. Spencer: Carcinoids do not bleed. Those that occur in the appendix are invari-
ably benign. Those that occur in other parts of the intestinal tract may metas-
tasize.
Dr. G. Govatos: I believe she had a tumor invaginating the wall. Either a polyp
or a lipoma comes to my mind. Some roentgenologists think that submucous lipomas
are a little more translucent.
Dr. Barnett: That would depend on the size.
Dr. Govatos: Another thing one must remember about submucous lipomas is that
if they get large enough they might bleed.
Dr. C. R. Edwards: I believe that the most important feature of this case is the
intermittent diarrhea and the smoothness of the deformity in the right colon. As a
rule, of course, we know that any neoplasm in the right colon may lead to anemia.
There are few exceptions. The so-called "napkin-ring" carcinoma which does not
extensively ulcerate is one. The majority of the malignancies of the right colon are
of the ulcerative type. When a patient of this age is presented with anemia and a
tumor in the right colon, carcinoma is the most probable diagnosis. Many neoplasms
of the right colon are not obstructive. This woman's symptoms were indicative of
obstruction. Prolapse of a polyp with the formation of an intussusception would
probably cause bleeding. In the chronic types of intussusception blood often appears
in the stools. Whether it is a prolapse or whether it is an intussusception, if it is
going to cause as much deformity as is seen in the roentgenograph in this case, almost
invariably it will be associated with some blood in the stools. This case emphasizes
42 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
the importance of doing an exploratory laparotomy where questionable roentgeno-
logic findings couple with signs of partial colic obstruction.
It is a very unfortunate thing that the majority of the diagnoses of endometriosis
are not made prior to operation. If one will examine the history of a case where endo-
metriosis is definitely defined by operation and pathologic studies, intermittent
regression of the symptoms will be indicated. Endometriosis invading the bowel
wall has been reported in almost every segment of the colon.
Pathological Discussion
Dr. H. R. Spencer: The gross specimen in this case consisted of the cecum and 29
cm. of terminal ileum. The ileum was acutely angulated and adherent to the side
of the cecum. The serous surfaces were otherwise normal. Longitudinal section
through the cecum, ileum, ileocecal valve and ascending colon showed the ileocecal
ostium to be surrounded by pouting resilient mucosa and submucosa that protruded
1.5 cm. into the colon. This deformity consisted of a doughnut shaped protrusion
of ileal mucosa that was pushed distally by excessive growth of submucous fat.
The stroma was edematous and sparsely infiltrated by lymphocytes. There was no
evidence of ulceration or malignancy.
This is a case in which partial intussusception and obstruction were caused by a
submucous lipoma. Lipomas of the intestinal tract are not common. They arise
either in the adipose tissue of the submucosa or of the subserosa. The submucous
tumors of this type usually are not large but in about one-half of the cases can cause
intussusception.
Diagnosis: Submucous lipoma, terminal ileum.
OBSTETRIC CASE REPORT*
The patient, an 18 year old secundigravida was admitted to the hospital at 2: 15
A.M., October 20, 1950 in advanced labor. Her first pregnancy was accompanied by
pre-eclampsia, and terminated with a living baby. Her present prenatal course was
entirely satisfactory.
Labor began at 1:45 A.M., at home. On admission she was ready for delivery. A
saddle block anesthesia was instituted at 2:30 A.M., and at 2:50 A.M. she was
delivered spontaneously and without lacerations of a full term, living, female child.
The delivery was rapid. At 2:55 A.M. the placenta and membranes were expressed
intact. Immediately following completion of the third stage, pitocin was given in-
tramuscularly. Cervical inspection and vaginal inspection were negative.
Two hours postpartum there was moderate vaginal bleeding with uterine relaxa-
tion; however, the uterus would become firmly contracted when massaged. Five
hours postpartum, she began to bleed profusely, and massage only moderately con-
trolled the hemorrhage. Intravenous fluids were started with one ampule of pitocin
added to 500 c.c. of 5 per cent glucose administered at a moderately rapid rate.
Within a very few minutes the uterus contracted firmly and continuously and bleed-
ing ceased. Her further course was uneventful.
Diagnosis: Delayed postpartum hemorrhage as a result of uterine atony.
Discussion: The cause of postpartum uterine atony is unknown. We do know
that it follows precipitate and prolonged labors, hydramnios and twin pregnancies.
In its treatment there is one maneuver that may prophylactically decrease its in-
cidence. That procedure is the slow extraction of the baby, particularly after the
head has been born. Forty-five to 60 seconds should be used to deliver the remainder
of the body. This aids in immediate placental separation and decreases the third
stage blood loss.
Active therapy should consist of the following: 1) preparation for immediate trans-
fusion and liberality in its use; 2) massage, either externally or a combination of the
fist in the vagina against the uterus and the external hand massaging the uterus;
3) intravenous ergotrate; 4) pitocin as was given to the above patient; that is, as
an intravenous drip in isotonic glucose or normal saline; 5) manual exploration of
the uterus, and visual inspection of the cervix and vagina for retained secundines
and lacerations; and 6) if uncontrollable with these methods, an abdominal hys-
terectomy should be done.
All cervical and vaginal lacerations should be repaired immediately. In many in-
stances abdominal hysterectomy is postponed too long with disastrous results to the
mother. If the first 5 steps do not control the hemorrhage, other procedures, such
as packing of the uterus will probably be of no avail. Hysterectomy is then a life-
saving procedure.
* From the Department of Obstetrics, Univ. of Maryland, School of Medicine, Baltimore.
43
BOOK REVIEWS
Textbook of Bacteriology. Joseph M. Dougherty, A.B., M.A., Ph.D., Dean of the School of Science
and Professor of Bacteriology, Yillanova College; and Anthony J. Lamberti, B.S., M.S., Instructor
in Bacteriology and Parasitology, Temple University School of Medicine. The C. V. Mosby Com-
pany, St. Louis, Missouri, 1950. 491 pp. Price $5.75.
This is a text for undergraduate students and is well-suited for introducing bacteriology to pre-
medical and pre-dental students and for nurses' instruction.
The student is introduced to the subject by way of a rather concise, though highly informative,
review of the history of bacteriology. This is followed by a chapter on microscopy; a logical sequence
since much of the rapid progress in the development of bacteriology depended upon the perfection
of the compound microscope. The chapter on microscopy is extended to include the valuable con-
tribution of the electron microscope to bacteriology.
Those chapters dealing with bacteriologic technique, apparatus, cultural methods and staining
are well presented and are amply supplemented with tables, illustrations, and diagrams which are
too often slighted in elementary texts. Such treatment of these phases of bacteriology is of practical
value. The effects of physical and chemical agents on bacteria are well-treated and a chapter on
chemotherapeutics is remarkably well up to date.
Six chapters are devoted to various phases of the infectious process, immunology and serology.
Particularly impressive is the thoroughness with which the complement fixation reaction is con-
sidered, the procedure demonstrated being a modification perfected by Dr. John A. Kolmer. These
chapters would serve well in the establishment of a foundation in immunology and serology for the
elementary student in bacteriology.
Some twenty groups of organisms are considered with regard to morphology, cultural character-
istics, pathogenicity for man and animals, immune and serologic responses elicited, therapy and
other information where pertinent; for example, toxin production, antigenic types, specific tests and
distribution of the organism. The inclusion of the actinomycetes, pathogenic fungi, rickettsia and
filtrable viruses produces a well rounded representative presentation of pathogenic microorganisms.
Chapters dealing with the bacteriology of water, milk and food as well as the parasitic protozoa
are of practical value to the future technician.
The reviewer feels this text to be an excellent one for introducing the science of medical bac-
teriology to the undergraduate student destined to major in medicine or an allied field. It is written
in a style which is both lucid and vivid and for the student interested in enlarging upon the basic
presentations, there is an ample provision of references to original investigation or other authorita-
tive sources.
Andrew G. Smith, Ph.D.
Freud: Dictionary of Psychoanalysis. Edited by: Nandor Fodor and Frank Giynor. The Philo-
sophical Library, Inc., New York, 1950. Price, $3.75.
It would be an almost impossible task to measure the extent of current professional and lay in-
terest in Freud's system of psychoanalysis. This wide-spread popularity of psychoanalysis has caused
much of its terminology to become a part of the vocabulary of the average layman with the result
that far too many Freudian concepts and terms have been distorted and have lost their original
meaning. This is so true that the interested, intelligent layman, the beginning student of psycho-
analysis, and the researcher, have had a difficult time determining just what was Freud's definition
and meaning of his terms. The only recourse open to those who desire to know authoritatively what
Freud meant is either to wade through his voluminous tomes or else seek out a psychoanalytic ex-
pert— neither of which is practical or satisfactory. This problem, happily, no longer exists, thanks
to the fruitful efforts of the editors of the Dictionary of Psychoanalysis.
This book should prove useful and practical to anyone who is interested in psychoanalysis. It is
an authoritative, well planned, comprehensive Freudian glossary, alphabetically arranged, with an
introductory key to references to complete and further simplify its use. This publication is thorough
and leaves little to be desired by those for whom it is intended. The format and the selection of
44
BOOK REVIEWS 45
type is attractive, makes for easy reading and contributes to the book's value. As a hand}' reference
this volume belongs on the shelf of students and critics of psychoanalysis. The editors, aptly state:
"This is a book that should satisfy a long-felt need" and we are pleased to recommend it.
Frank J. Ayd, Jr., M.D.
The Management of Obstetric Difficulties. Paul Titus. 4th Edition, 1950. The C. V. Mosby
Co., St. Louis, Missouri. Price $14.00.
In its first 3 editions, this volume has been characterized by excellent evaluation of abnormal
obstetrics and of sterility. The fourth edition follows this same pattern. With particular reference
to management, the subject matter in many instances is unilateral in its approach and frequently
omits the points of view of other obstetricians which are in opposition to the author. By and large,
this is not true, and a well rounded plan of management for an)' one obstetric difficulty can be ob-
tained. Man}' of the sections have been enlarged, such as diabetes, placenta previa, German measles,
with the addition of new sections dealing with granuloma inguinale, multiple sclerosis, infectious
hepatitis and poliomyelitis.
There have been advances made in classification and terminology with the agreement of Titus,
McCormick, Greenhill and Eastman in their four major textbooks. The classifications of the toxe-
mias of pregnancy have been agreed upon as well as the definition of placenta previa and the elim-
ination of the term premature separation of the placenta with abruptio placenta substituted. This
agreement will enable obstetricians in general to more clearly evaluate and interpret results of the
management of these three obstetric difficulties.
There is some misplacement of values from the standpoint of space dedicated to some obstetric
difficulties. For example, only three or four pages are devoted to the management of the frequent
complication of contracted pelvis, while some 11 to 12 pages are devoted to the preparation and
use of dextrose solutions. This may well represent enthusiasm on the part of the author for this
particular form of intravenous therapy.
The illustrations are not only numerous and well planned, but also expertly prepared. On the
whole, the textbook is clearly written, well programed and can be recommended for both reference
and teaching.
D. Frank Kaltreider, M.D.
MEDICAL SCHOOL SECTION
GENERAL PATTERSON DIES
Dr. Robert U. Patterson
Major General Robert Urie Patterson, MC, USA, (ret.), former Surgeon General
of the United States Army and Dean Emeritus of the School of Medicine, died on
December 6, 1950 at Walter Reed Hospital, Washington after a short illness, aged 73.
General Patterson was born in Montreal, Canada in 1877, receiving his medical
degree at McGill University in 1898. In 1901 he joined the Medical Corps of the
United States Army and after a succession of stations in the Philippines and at
various army posts throughout the United States he became Chief of a Medical
Unit in World War I.
In 1931 he was raised from the rank of Colonel to Major General and appointed
Surgeon General of the Army, serving in this capacity until 1935 when he was re-
tired. He then became Dean of the University of Oklahoma School of Medicine,
from which post he was appointed Dean of the School of Medicine of the University
of Maryland, serving in this capacity from 1942 until 1946 when he was forced to
ii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF Ml).
retire because of ill health. As Dean of the School of Medicine during the war years,
his forceful personality contributed greatly to the maintainence and continuation
of high standards during a time when medical school faculties and educational fa-
cilities were subject to considerable depletion.
He was instrumental in the institution of a program which ultimately lead to the
expansion of the post graduate training facilities of the School of Medicine. During
the war years he initiated the Planning Committee which was largely responsible
for the constructive post war program which is still in progress.
CANCER SEMINAR PROGRAM— 1950-51
Third Wednesday in every month from 4 until 5 P.M. (unless otherwise noted)
Date Speaker Subject
Monday, January 22, 1951, Dr Sidney Farber Tumors in children
at 5 P.M. Children's Medical Center
Boston, Mass.
February 21, 1951 Dr. Richard Sweet Carcinoma of the esophagus
Mass. General Hospital
Boston, Mass.
The remainder of the year's program has not been completed.
ARMY SURGEON GENERAL EXPLAINS MEDICAL DRAFT
COMMISSION DEADLINE
In response to numerous inquiries relative to the final date on which draft eligible
physicians and dentists may receive preinduction reserve commissions, Major Gen-
eral Raymond W. Bliss, Army Surgeon General, emphasized today that the me-
chanics of processing applications preclude the guarantee of a commission to a reg-
istrant if he applies after receiving his induction notice.
This commission deadline, General Bliss explained, is the result of administrative
considerations. Section 5 of Public Law 779, 81st Congress, simply provides that
"no person inducted under the provisions of this Act shall be entitled to the benefits
of the provisions of Section 203 of Public Law 351, 81st Congress." {$100.00 monthly
incentive bonus — ed.) However, for physicians and dentists to qualify as volunteers,
and thus for the special professional pay authorized under Public Law 351, all proc-
essing required for a reserve commission must be accomplished and appointment
made prior to induction.
"Because of the work load involved in processing an application for reserve com-
mission, and the controls necessary for a decentralized Selective Service system, as
well as a decentralized Army appointment system, we simply cannot guarantee that
a registratn can receive his commission in time if he applies after he has received
his induction notice," General Bliss said. "This, of course, does not preclude any
registrant applying for his commission after he has received his induction notice,
and if he receives a commission before actual induction, he is entitled to all the
benefits provided for commissioned officers."
MEDICAL SCHOOL SECTION iii
DEPARTMENT OF PHARMACOLOGY
Go Lu, M.D., was appointed a Fellow in Pharmacology as of September 1, 1950.
Dr. John C. Krantz, Jr., gave the Convocation address at the University of
Buffalo on October 20, and while in Buffalo spoke to the staff of the Maternity
Hospital of the University of Buffalo, and addressed the annual banquet of the
Torch Club of the city.
APPOINTED ASSISTANT PROFESSOR OF PHARMACOLOGY
Dr. Raymond M. Burgison
The appointment of Dr. Raymond M. Burgison as Assistant Professor of Phar-
macology was announced on September 1, 1950.
Dr. Burgison, a native Baltimorean and a graduate of Loyola College, received
his Doctor of Philosophy degree from the University of Maryland School of Phar-
macy in June, 1950. During his postgraduate training he held the Ohio Chemical
Company Fellowship in the School of Medicine from 1948 to 1949, and from 1949
to 1950 was the Eli Lilly Fellow in Pharmacology. Prior to his entrance into the
graduate school of the University he worked as an industrial research chemist and
during World War II was active in rubber research.
In the department of Pharmacology, Dr. Burgison will continue investigations
with drugs used in the treatment of cardiovascular diseases.
iv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
DEPARTMENT OF PHARMACOLOGY
The Department of Pharmacology has received a grant of $4500 from Eli Lilly &
Company for the study of cardiovascular drugs, and a grant of $3500 from the Air
Reduction Company for a continuation of studies in anesthesia.
Go Lu, M.D., is enrolled as a graduate student in this department.
Dr. John C. Krantz, Jr., gave 5 lectures at the Atlantic City General Hospital
and served as a consultant to the hospital for the week of June 11.
Dr. Krantz will be the speaker at the annual banquet of the Surgical Society of
San Diego, California, September 13, and will also speak on September 14 at the
Medical Society of Hollywood.
GRANT AWARDED
A recent grant of $6,000 from the United States Public Health Service has been
awarded to the Department of Pharmacology for continuing studies in the phar-
macology of drugs applicable to the treatment of hypertension.
NOTES FROM THE DEPARTMENT OF OBSTETRICS
On July 1, 1950, Dr. Schuyler G. Kohl resigned from our faculty to accept an
appointment under Dr. Louis M. Hellman, Professor of Obstetrics, and Gynecology
at the State University of New York, School of Medicine, at Brooklyn, New York.
New appointments to the obstetric staff of the school include: Drs. J. Tyler
Baker, Harry McB. Beck, Wm. A. Dodd, Irvin P. Klemkowski, Clarence W.
Martin and Harry Cohen.
At the November meeting of the Southern Medical Association in St. Louis there
were two papers presented by members of the obstetric department. The first was
by Drs. J. M. Reese and C. W. Martin and the second by Drs. I. A. Siegel and
H. B. McNally. In both instances, the paper was read by the senior author.
With sorrow we report the sudden and untimely death of Dr. Robert F. Linn
on Sept. 27, 1950. Dr. Linn was resident in obstetrics at the University Hospital
1941-42 after which he entered the armed forces, and upon completion of his tour
of duty, went into practice in Cleveland, Ohio, his home. A successful obstetrician,
Dr. Linn enjoyed the respect of his confreres. Dr. Linn was just 40 years of age
when he died, death being due to coronary occlusion.
Dr. W. Paul Dailey, Harrisburg, Pa., resident in obstetrics at the University
1930-32 was recently elected President of the Harrisburg County Medical Society.
"DOUGTRICLVNS" ORGANIZE
In June 1949 a number of the past obstetric residents of the University and Balti-
more City Hospitals met at the University Hospital to organize "the dougtricians."
All present were former residents of Dr. Louis H. Douglass, thus the derivation
of the name of the society. The meeting consisted of clinics and case presentations.
In the evening a dinner was held at the Baltimore Country Club. A permanent or-
ganization was formed at this initial meeting.
The second annual meeting and dinner was held at the Hotel New Yorker, New
MEDICAL SCHOOL SECTION v
York, in May 1950 in conjunction with the International and Fourth American
Congress of Obstetrics and Gynecology. Eighteen members were present. Dr. Louis
H. Douglass, the guest of honor, made a brief talk. Dr. J. Morris Reese, Presi-
dent, presided.
It is planned to hold the third annual meeting in June 1951 in conjunction with
the Medical Alumni meetings.
Dr. John C. Krantz, Jr., Professor of Pharmacology, has been recently elected
an honorary member of the Hollywood Academy of Medicine, Hollywood, California.
DEPARTMENT OF DERMATOLOGY
Recent publications by the Department of Dermatology include the following.
By Drs. H. M. Robinson, H. M. Robinson, Jr. and H. V. Link — Studies in the
Treatment of Tinea Capitis. (I) Furaspor in the Treatment of Tinea Capitis. Bull.
Sch. Med., U. of M.
By Dr. Israel Zeligman — Red Fluorescence of Urine in Wood's Light as Aid in
Office Diagnosis of Poprhyria. Archives of Dermatology and Syphilology. May 1950.
By Dr. Francis A. Ellis — The Vesicular Form of Darier's Disease (so-called benign
familial pemphigus). Archives of Dermatology and Syphilology. May 1950.
By Dr. Eugene Bereston — Treatment of Kaposi's Varicelliform Eruption with
Aureomycin. Archives of Dermatology and Syphilology.
By Dr. H. M. Robinson — Chloramphenicol (Chloromycetin) in the Treatment of
Chronic Discoid Lupus Erythematosus. Journal of Investigative Dermatology. May
1950.
Aureomycin in the Treatment of Some Dermatoses. Archives of Dermatology and
Syphilology. March 1950.
By Drs. H. M. Robinson and H. M. Robinson, Jr. — Terramycin in the Treatment
of Early Syphilis and Gonorrhea. (In preparation.)
Studies on Chloramphenicol in Early Syphilis and Gonorrhea. Southern Medical
Journal. November 1949.
The Antibiotics in the Treatment of Early Syphilis and Syphilis Complicated by
Pregnancy. Read at the American Medical Association Meeting. 1950.
The Use of Aureomycin, Oral, Intravenous and by Local Application in the Treatment
of Dermatoses. To be read in November 1950 before the section of dermatology of the
Southern Medical Society.
By Drs. H. M. Robinson, H. M. Robinson, Jr. and R. C. V. Robinson — The Thera-
peutic Value of Aureomycin in Dermatitis Herpetiformis. The Journal of Investiga-
tive Dermatology. July 1949.
By Dr. R. C. V. Robinson — Benzyl Benzoate in the Treatment of Tinea Capitis.
October, 1949.
By Dr. H. M. Robinson, Jr. — Comparative Analysis of the Mucocutaneous Ocular
Syndromes. Archives of Dermatology and Syphilology. May 1950.
The Ocular Mucous Membrane Syndrome. Accepted for publication in the Medical
Clinics of North America.
Keratosis Follicularis. Archives of Dermatology and Syphilology. July 1950.
Dr. Francis A. Ellis and William Bundick will present an exhibit at the Southern
vi BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Medical Meeting in St. Louis in November, 1950, entitled: The importance of Biopsy
in Diagnosis and Prognosis in Classification of Lupus Erythematosus.
Dr. H. M. Robinson, Jr. is preparing an exhibit on Visual Aids in the Teaching of
( Tnder-graduate Dermatology.
Drs. H. M. and R. C. V. Robinson recently presented a paper on Modem Approach
to Skin Diseases at the Peninsula General Hospital, Salisbury, Maryland.
Dr. H. M. Robinson, Jr. recently lectured at the Howard University Medical
School, Washington, D. C. on Rarer Dermatoses.
DEPARTMENT OF PSYCHIATRY
New appointments in the clinical staff of the Department of Psychiatry are Dr.
William N. Fitzpatrick, Dr. Enoch Callaway, III, Dr. Marion W. Mathews, Dr.
Marvin Jaffee and Dr. Virginia Suttontield. Dr. Robert G. Grenell has been appointed
Research Associate in Psychiatry and Miss Jeannette Rayner and Mr. David Willen-
son have been appointed Research Assistants. Dr. Ephriam T. Lisansky has been
promoted to the position of Associate in Psychiatry.
A contract for "Psychological Studies on the Effects of CW Agents" has been
awarded to the Department by the Chemical Corps Procurement Agency, Depart-
ment of the U. S. Army. Support for a research project on "Effects of Anoxia on the
Electroencephalogram and on Behavior", which has been transferred from the Har-
vard Medical School, has been granted by the Office of Naval Research, Department
of the Navy.
The Myer Dana Lectureship in Psychiatry has been established through the gen-
erosity of Mr. Herman Dana of Boston. A grant for the support of "Studies in Med-
ical Logic" has been likewise received from Mr. Herman Dana, Boston.
Dr. Robert G. Grenell has read papers on "Effects of High Potassium on In
Vivo Respiration and DC Potential of Cerebral Cortex" and "In Vivo Respiration
of the Cerebral Cortex in the Absence of Glucose" at the Federation of Biological
Sciences, and a paper on "Effects of Nembutal on the In Vivo Oxygen Consumption
of the Cerebral Cortex" at the Annual Meeting of the American Neurological Asso-
ciation.
Dr. Whitman Newell was elected to the Presidency of the American Orthopsy-
chiatric Society at its annual meeting in Atlantic City. He is also President of the
Baltimore Psychoanalytic Society.
Dr. Jacob E. Finesinger read a paper on "Managing the Emotional Problems of
the Cancer Patient" at the annual meeting of the Georgia Medical Society, and in
collaboration with Dr. John R. Reid, read a paper, "Inference Testing in Psycho-
therapy" at the annual meeting of the American Psychiatric Association. He has
also read papers before the Washington County Medical Society, the Frederick
County Medical Society, the Baltimore City Medical Society and the Maryland
Medical and Chirurgical Faculty and the Washington Psychiatric Society. Dr.
Finesinger has been named to the editorial board of the American Journal of Clinical
Investigation and has been appointed a special consultant to the National Institute
of Mental Health.
MEDICAL SCHOOL ^SECTION vii
DEPARTMENT OF SURGERY
Dr. Joseph Ganey delivered a paper on "A Study of Intestinal Flora" at the an-
nual meeting of the American College of Surgeons in Boston.
Dr. William D. Lynn, who completed his Residency in Surgery in July, 1950, has
been appointed full-time Associate in the Department of Experimental Surgery and
Clinical Research. Dr. Lynn will continue his activities in the further organization
of the research program of the Department of Surgery.
For the past several years the Department of Surgery has maintained an active
affiliation with the Department of Surgery of the Peninsula General Hospital at
Salisbury, Maryland, where one Assistant Resident from the Department of Surgery
has been assigned on a rotating basis, changing quarterly. On July 25, 1950, an ad-
ditional Assistant Resident was assigned to the Peninsula General Hospital for a
6 months rotating service.
The American Board of Surgeons recently accepted Drs. William B. Long, Henry
A. Briele and William H. Fisher, Jr. of the Department of Surgery, Peninsula Gen-
eral Hospital, as preceptors. These three physicians are all alumni of the University
of Maryland School of Medicine and received the greater part of their training at
the University Hospital.
Recent papers published by the Department of Surgery include:
An Attempt to Establish Collateral Circulation to the Myocardium. D. A. Reimann,
R. A. Cowley and W7. T. Raby. Bull. Sch. Med. U. of M., 35: 1, (Jan.) 1950.
Aureomycin and Chloromycetin (Chlorocamphenicol) in the Treatment of Experi-
mental and Clinical Peritonitis. George H. Yeager, W. L. Birely, W. A. Holbrook,
W. D. Lynn and T. G. Barnes. Bull. Sch. Med. U. of M., 35: (Apr.) 1950.
The Treatment of Peritonitis of Appendiceal Origin with Aureomycin. George H.
Yeager, W. D. Lynn and T. G. Barnes. This paper will be published in The Southern
Surgeon.
Drs. A. R. Mansberger, Jr., George H. Yeager, R. M. Smelser and F. M. Brum-
back have completed a paper entitled A Study on Sapheno-F emoral Junction Anoma-
lies which will appear in the October, 1950 issue of Surgery, Gynecology and Ob-
stetrics.
A paper entitled Terramycin in Peritonitis; Experimental and Clinical was read
before the Conference on Terramycin at the New York Academy of Sciences in
June, 1950 by Drs. George H. Yeager, A. R. Mansdorfer, Jr., C. D. Thomas, Jr.
and T. G. Barnes. This paper will be published in a forthcoming issue of the academy
journal.
MERCY HOSPITAL
Dr. Edgar B. Friedenwald, class of 1903, P & S, resigned on March 10, 1950,
as Professor of Clinical Pediatrics in the School of Medicine.
Dr. Walter D. Wise, class of 1906, P & S, is President-elect of the Medical
and Chirurgical Faculty for 1951.
Dr. Edward R. Dana was appointed Director of Radiology at Mercy Hospital
and Associate in Roentgenology on the Faculty of the School of Medicine, July
1950.
viii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Dr. Harold P. Biehl, class of 1940, Resident Surgeon at Mercy Hospital from
September 1, 1946 to August 31, 19-17, has opened an office at 11 East Chase Street,
Baltimore.
Dr. Michael L. DeVincentis, class of 1941, Resident Surgeon at Mercy Hos-
pital from September 1, 1947 to August 31, 1948, became a Fellow of the American
College of Surgeons on October 27, 1950.
FRIEDENWALD LECTURE
The Dr. Julius Friedenwald Memorial Lecture was given on Thursday, Novem-
ber 2, 1950 at 8:30 P.M. Dr. Andrew C. Ivy, Vice-President of the University of
Illinois spoke on "Physiologic Basis of the Psychosomatic Aspects of Peptic Ul-
cer."
MERCY ORGANIZES CHEST CLINIC
In conjunction with the residency program in thoracic surgery established at the
University Hospital, a chest clinic has been organized at Mercy Hospital to augument
this training.
A resident from the thoracic surgery service will spend two years in this specialty
with portions of his first year spent at Mercy Hospital in the bronchoscopic clinic.
Here he will receive instruction and practical experience in bronchoscopy, laryngos-
copy and esophagoscopy. During this time he will also observe all the cases of tho-
racic diseases admitted to the hospital.
Dr. William L. Garlick, recently appointed chief of thoracic surgery at Mercy
Hospital will be in charge.
PROGRESS NOTE
ill!
1 I JH
riii
View of site for new Psychiatric Hospital as of November 1, 1950, showing progress of excavation
and foundation
MEDICAL SCHOOL SECTION ix
MEDICAL LIBRARY NOTES
Displayed on the balcony of the Medical Library is a collection of literature with
illustrations on the modern treatment of poliomyelitis. This display was arranged by
Miss Grace E. Shaw, Physical Therapist in the University Hospital
Personal Donors to the Library
August-October, 1950
Mr. Thomas C. Desmond Dr. C. Reid Edwards
Mrs. Preston W. Fishbaugh Dr. N. J. Gould
Dr. Frank W. Ffachtel Mrs. John G. Jeffers
Dr. Vernon Krahl Dr. Arthur M. Kraut
Dr. Enrique Llamas Dr. William B. Patterson
Dr. Maurice C. Pincoffs Dr. A. F. Thompson, Jr.
Dr. H. Boyd Wylie Dr. D. L. Wilkinson
Besides individuals who make gifts of books and journals, various foundations,
pharmaceutical firms, medical organizations, and other libraries present material to
this library.
It has been mentioned before in the Bulletin what a gratifying response has been
made by alumni and other friends of the library to the request for medical journals.
One alumnus from Jersey City, New Jersey has been faithfully shipping discarded
medical journals to Baltimore ever since the request appeared. The librarian recently
received the following letter from this same alumnus:
"Dear Mrs. Robinson:
I have been sending you so many old medical journals that I think a few new books
would not be amiss. Will you therefore send me a list of some of the publications de-
sired by the library and I will be pleased to select some of them and have them sent
to you.
I am glad that you consider me a friend to the library. I recall the many services
and benefits that the medical library rendered to me when I was a student at the
University.
Arthur M. Kraut, M.D."
This letter is just one example of the interest which medical alumni show in the
development of the library.
THE UNIVERSITY OF MARYLAND
BIOLOGICAL SOCIETY
R. Dale Smith, Ph.D. George P. Hager, Ph.D.
President Secretary
During the academic year, 1949-50 the University of Maryland Biological Society
completed the following programs which are listed below.
November 16, 1949
Dinner Meeting: Park Plaza Hotel, Baltimore. Speaker: Dr. R. P. Silirie, Medical
Division, Merck and Co. Topic: Cortisone — Its Chemistry and Physiological Properties.
December 14, 1949
Chemical Hall, School of Medicine. Speaker: Dr. Dexter L. Reimann, Associate
Professor of Pathology, School of Medicine. Topic: An Attempt to Establish Collateral
Circulation to the Myocardium. (Bull. Sch. Med., U. of M.; 35: 1, (Jan.), 1950.)
In addition, Dr. Edward B. Truitt of the Department of Pharmacology, School of
Medicine spoke on Techniques in the Measurement of Coronary Blood Flow.
Studies cf coronary blood flow on theophylline compounds by numerous methods were studied. A method of measur-
ing the normal rate of flow as well as accurately reflecting the increases caused by changes in the coronary vascular bed
were considered. The paper continues with the numerous techniques employed in the measurement of coronary blood flow
in various physiologic states.
January 18, 1950
Dinner Meeting: Park Plaza Hotel, Baltimore. Speaker: Dr. Samuel R. M. Rey-
nolds, Department of Embryology, Carnegie Institution of Washington. Topic:
Fetal Maturity at Birth.
In the past, a yardstick for fetal maturity has been sought in the nature of fetal development itself, and explained on
genetic grounds alone. Consideration of facts obtained in laboratory and domestic animals, as well as in certain races of
women shows that the control of fetal size at birth is a function of fetus : maternal relationships; that fetal size is governed
in part by the relation of the size of the uterus to the size of the fetus, and that in every' species studied, a relationship
exists between the size of the fetus and the shape of the uterus about the conceptus. Maturity, however, is independent
of size, except in broad terms, among different species.
There is a period of embryonic development in each species in which the uterus about the conceptus is essentially
spheroidal. After a definite period of time in each species, the fetus commences to increase rapidly in size, and the uterus
about the conceptus assumes a cylindrical shape. This change over in pattern of uterine enlargement is rapid, and occurs
at a nearly fixed time in each species. It is called the conversion period. Using this as a fixed point in the fetus : uterine
relationship, it is found that the maturity of the fetus at birth is a function of the proportion of the total duration of
pregnancy which the fetus spends in an elongating or cylindrical uterus. This is substantiated by considering such diverse
factors as appearance of ossification centers, resistance of newborn to anoxia, development of regulation of body tempera-
ture, and general somatic development.
February 16, 1950
Bressler Library, University of Maryland. Speaker: Dr. Edward Steers, Depart-
ment of Bacteriology, School of Medicine. Topic: The Mode of Action of
Sulphonamides.
UNIVERSITY OF MARYLAND BIOLOGICAL SOCIETY
Two hypotheses are offered to explain the inhibition of growth of bacteria by sulfonamides. (1) The Wood-Fildes Hy-
pothesis (1940) which holds that p-aminobenzoic acid, a structural analogue of sulfanilamide, is an essential metabolite.
(2) The Group represented by Sevag and his co-workers (1942, 19461 who feel that sulfonamides act upon respiratory en-
zymes thus interfering with respiration essential to growth. Sevag postulates that p-aminobenzoic acid is a non-toxic
analogue of sulfanilamide which it can displace non-specifically from any enzyme surface without itself being inhibitory.
The majority of data reported s:nce 1940 would tend to support and strengthen the Wood-Fildes hypothesis. I'ara-
aminobenzoic acid has been shown to be a growth factor for certain organisms. Rubbo and Gillespie (1940) and Blanchard
(19411 isolated it from yeast. Ratner et al., (1944) reported p-aminobenzoic acid to exist in a bound form as a glutamic
acid peptide. Angier et al., (1946) established the structure of the peptide as consisting of pterin, p-aminobenzoic acid
and glutamic acid moieties. The intact molecule is pteroylglutamic acid or folic acid. Miller (1944) demonstrated the de-
creased synthesis of folic acid by Escherichia coli in the presence of sulfanilamide. Harris and Kohn (1941 ), Bliss and Long
(1941) and Lampen and Jones (1949) presented evidence which would tend to involve p-aminobenzoic acid in the metab-
olism of amino acids and purines.
Work and Work (1948) on the basis of the foregoing evidence have proposed the following modification of a scheme orig-
inally devised by Kohn (1943) to explain the mode of action of sulfonamides.
PABA
+
pterin
+
^ glutamic
acid
+
Unknown
Metabolites
Primary Reaction
( Folic acid
+A
}- Inhib by
+B
Sulfonamides
+c
I +D
E I
F
Secondary Reaction
Products essential
for growth
The work of Lampen and Jones (1947) and Miller (1944) play an important part in the formulation of the above scheme.
Miller (1947) in an extension of her original work reported that sulfonamide not only inhibited the synthesis of folic acid
by a susceptible strain of Escherichia coli, but also the synthesis of pantothenic acid. The latter synthesis was 60X more
sensitive to sulfonamide than the former. Furthermore, while the synthesis of folic acid by the resistant strain (developed
from the parent susceptible) was still moderately inhibited by sulfonamides, the synthesis of pantothenic acid was not
only insensitive to sulfonamides, but also 50 per cent in excess of that of the control. Wright and Skeggs (1945) found that
high protein diets protected rats against folic acid blood dyscrasias induced by feeding sulfasuxadine. High fat and high
carbohydrate diets failed in this respect. Folic acid content of the feces and liver was lowered in all instances regardless
of diet where sulfasuxadine was present in the diet. In contrast, pantothenic acid content was normal with the high protein
diet plus the drug.
Sevag et al. (1950), report that folic acid per se is not a growth factor for Lactobacillus arabinosus (17-5), but that the
degradation products of folic acid (Sevag and Koft (1949)) are responsible for the growth stimulation. Furthermore, the
apparent non-competitive antagonism between folic acid and sulfanilamide results not from the folic acid but to the con-
trol of the pH of the medium. These findings are not compatible with those of Lampen and Jones (1947) and would tend
to argue against the conversion, by this organism, of p-aminobenzoic acid to folic acid
Fisher and Armstrong (1947) reported that the respiration of Escherichia coli associated with nitrogen fixation and cell
synthesis was as sensitive to sulfonamide inhibition as was growth itself. The adherents of the Wood-Fildes school interpret
these results as well as Sevag's respiration studies as secondary effects.
In conclusion it should be remembered that as yet there is no direct conclusive evidence as to the actual site and mode
of sulfonamide action.
March 16, 1950
Joint meeting with the Society for Experimental Biology and Medicine — Bressler
Library, University of Maryland. Speakers: B. F. Chow, C. A. Lang and L. Barrows.
Subject: The Effect of Certain Vitamins on the Biological Activity of Bi2 in Vitro and
in Vivo and The Urinary Excretion of Vitamin B12 after Oral and Intramuscular
Administration to Normal Human Subjects (with R. L. Davis and L. C. Conley).
Dr. Edward J. Herbst of the Department of Biochemistry, School of Medicine
spoke on New Growth Factors for Hemophilus Parainfluenzas
Drs. H. C. Johnson, A. E. Walker and C. Marshall of the Department of Neuro-
surgery, Johns Hopkins University spoke on The Effect of Topical Application of
Convulsant Drugs on Normal Cortex and Epileptogenic Cortical Foci in the Macaque
Monkey.
xii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
May 4, 1950
Bressler Library, School of Medicine. Speaker: Dr. R. M. N. Crosby, Department
of Neurosurgery, School of Medicine. Topic: Studies on the Chemistry of Cerebral
Pigmentation.
Contrary to the literature, pigments were found in abnormal spinal fluid which were neither carotine, bilirubin or hemo-
globin. A method for their extraction and separation from spinal fluid was given along with some of their gross chemical
characteristics. The pigmentation in Kernicterus, considered in the literature to result from bilirubin, on careful histo-
chemical studies showed no evidence of bilirubin but was rather lipoidal in nature. A third pigment called "wear and tear"
pigment appeared to be histochemically similar to that described in experimental animals with dietary cirrhosis (ceroid)
and identical with that of Vitamin E deficiency. A suggested method of extraction and preliminary purification of the
pigment was offered.
June 1, 1950
Dinner Meeting: Stafford Hotel, Baltimore. Speaker: Dr. R. G. Grenell, Depart-
ment of Psychiatry, School of Medicine. Topic: Metabolism and Function of the
Central Nervous System.
The present state of knowledge relative to the metabolic correlates of neuronal activity, is, to say the least, meager.
Most of the studies in this field have been performed in vitro, i.e., by the Warburg technique, or by means of such methods
as arterio-venous differences. The Warburg techniques have the inherent disadvantage of being carried out on tissue re-
moved from the animal and subjected to slicing, mincing or homogenizing. Under these conditions the same mechanisms
as the in vivo ones may not necessarily be functioning. The arterio-venous differences, in brain studies, for example, yield
over-all aspects which tells nothing of the events going on in the different regions of the brain, or in localize i, small groups
of cells.
In order to overcome these difficulties, investigations in the intact brain, with two basic technical procedures are being
pursued. Levels of oxygen tension and relative rates of oxygen consumption are obtained with the oxygen electrode de-
vised by Davies and Brink (Rev. Sci. Instr. 1942). Chemical control over a small cortical area is produced by local per-
fusion, through micro-cannulation of a pial arteriole. The standard perfusion fluid is a modified Krebs Solution plus
gelatine and glucose, equilibrated with 5 per cent CO2 at 38 C. This Solution is adequate to maintain the normal rate of
oxygen consumption for several hours.
Problems of anemia, anoxia, narcosis, etc. are being investigated with these methods. In a preliminary series of ex-
periments carried out with Dr. P. W. Davies, glucose was removed from the perfusate in order to ascertain the effects of
carbohydrate removal on the cells of the cerebral cortex. Thus far, no change in the rate of oxygen consumption has been
seen up to 2 hours of perfusion in the absence of glucose. This would imply either that these cells are burning protein or
fat directly, or that some form of carbohydrate is being synthesized and burned. The possibility of protein playing a major
role in the functioning of nervous tissue is a most intriguing one, and recent developments in chemistry enable one to set
up theories of this nature, the validity of which remains for future experiments to determine.
POST GRADUATE COMMITTEE SECTION
POST GRADUATE COMMITTEE, SCHOOL OF MEDICINE
Howard M. Bubert, M.D., Chairman and Director
Elizabeth Carroll,
Executive Secretary
Post Graduate Office: Room 600
29 South Greene Street
Baltimore 1, Maryland
MEDICO-LEGAL SEMINARS
The Seminar, announced in the October issue of this Bulletin is in its closing days
as this issue goes to press. The candidates, each selected to attend the Seminar by
the Heads of their respective Police Department, included senior Homicide Investi-
gators from the cities of Baltimore, Cumberland, and Hagerstown, and from Anne
Arundel, Baltimore, Montgomery, and Prince George's Counties. One out-of-state
officer, representing the Park Police of the United States Department of the In-
terior, also attended.
Dr. Richard Ford, Head of the Department of Legal Medicine at Harvard Medi-
cal School, brought a timely message in his discussion of "Identification in Disaster."
Using major disasters as examples, including the Coconut Grove Fire, the Texas
City Explosion, and the Noronic Fire, he outlined a plan for identifying the large
numbers of dead which might result from an atomic attack. He pointed out that the
only truly effective means of identification in such a disaster would be for each citi-
zen to wear a metal identification tag and advocated inclusion of this provision in
civilian defense planning. In large diasters resulting in many dead persons, certain
other things also must be done. Before moving the bodies from the scene of the dis-
aster, they must be tagged, and the tags must state exactly where they were found.
In order to prevent looting of jewelry and other valuables, which are of great value
in identification, large closed-body trucks, guarded by adequate police or militia
should be insisted upon.
Other out-of-state speakers and their topics were Dr. Milton Helpern, Deputy
Chief Medical Examiner of New York City, who spoke on "Concealed Murders";
Dr. Geoffrey Mann, Chief Medical Examiner of Virginia, whose topic was "The
Police and Medical Examiner Investigations of Rape"; and Mr. Frank Stratton,
Police Chemist, Boston City Police, who described "The Latest Advances in In-
vestigation of Traffic Deaths."
Student participation through study of the famous "Nutshell Studies of Crime"
was considered one of the most valuable features of the course. These are amazingly
accurate scale models of crime lent by their creator, Mrs. Frances G. Lee. The entire
enterprise was such a success that many leaders in police activities throughout the
State demanded its repetition, and, consequently, appropriate arrangements will be
made to repeat it at an early date.
xiv BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD.
HOUSE STAFF TRAINING
On July 1, 1948, the Obstetric Department of the University of Maryland School
of Medicine embarked upon a new venture in that it undertook to supply a house
officer in the allied fields of obstetrics and gynecology to the Peninsula General Hos-
pital at Salisbury, Maryland.
There were several reasons why this particular hospital was selected, among them
being the fact that these two services were already rather well organized and in
very competent hands. It was felt that the house officers assigned here would receive
good training and that the interests of a fairly large number of patients would be
well served. By means of an arrangement with the State Health Department, all
service obstetric cases in Wicomico County could be admitted to the Peninsula Gen-
eral Hospital, and, in this way, a considerable amount of clinical material would be
made available.
Before undertaking this project, the hospital was surveyed and approved by the
Committee of Post Graduate Education. The staff of the hospital agreed to abide
by certain rules and regulations regarding admissions and consultations. The chief
of the services was made a member of the obstetric staff of the University of Mary-
land School of Medicine with the rank of Associate in Post Graduate Medicine. The
chief of services agreed to attend and participate in weekly obstetric conferences of
the University and, in this way, to familiarize himself with the school's thoughts
and routines. To carry this same idea further, one of the senior members of the
obstetric visiting staff travels to Salisbury, Maryland monthly in rotation, and con-
ducts a conference.
Each member of the University Hospital staff serves one-fifth of a year at the
Peninsula General Hospital and four-fifths of a year at the University Hospital.
The general reaction of the 12 house officers who have served in this capacity is
that this is a very valuable part of their training. Being the only house officers on
these services, they have considerable responsibility and, also, are able to perform
many of the major operations.
In summary, it would appear that this has proved to be a very successful experi-
ment, and one which should be continued.
Report by Dr. Waller D. Wise, Chief of Surgery
The Annual Report of the Committee on Post Graduate Courses shows that much
thought has been given to post graduate training, and much has been accomplished.
There is no question of the need of such training in the State of Maryland and
there is little doubt that such training is largely the responsibility of the University
of Maryland. It is unfortunate that there should be confusion in the field best or-
ganized and the one in which post graduate teaching can be best accomplished,
namely that of our house officers. This is most evident particularly in surgery and
some of the specialities.
The standards have heretofore been set by several conflicting and overlapping
organizations: The American Medical Association, The American College of Sur-
geons, and the specialty boards. This confusion has at times caused hardship upon
men and hospitals. As a result of much complaint, we are now assured that clarifica-
POST-GRADUATE COMMITTEE SECTION xv
tion and simplification of requirements is at hand, and that "The Essentials of Ap-
proved Residencies and Fellowships is being revised. Copies of the revision will be
available for distribution within the next 30 days."*
World War II resulted in a lowering of some standards of hospital training and
interfered with the careers of many men. Some of them lost time and opportunities
they could not make up before standards were again raised. Now because of war,
standards will probably have to be changed once more. It will require clear thinking
and cool judgment to assure justice to the armed forces, civilian hospitals, young
doctors, and to the public.
WASHINGTON COUNTY
The Washington County Medical Society, through its Chairman of Post Gradu-
ate Courses, Dr. B. B. Kneisley, has requested the Post Graduate Committee of the
University of Maryland School of Medicine to give another series of six extension
lectures at the Washington County Hospital, Hagerstown, beginning on November
14. Dr. John H. Hornbaker is president of the Society, Dr. G. W. LeVan is vice-
president, and Dr. Ernest H. Poole is secretary-treasurer. The subjects to be in-
cluded in this year's series are Industrial Health, Neurologic Disorders, Pulmonary
Diseases, Gastroenterology, Medico-Legal Practice and Office Gynecology. Last year's
series at Hagerstown was very well attended, and the remarks sent to the Post
Graduate Office at the close of the season by Dr. Poole, who handled the arrange-
ments, were very gratifying to the Committee.
MARYLAND ACADEMY OF GENERAL PRACTICE
Dr. Lauriston L. Keown is arranging with the Post Graduate Committee for a
day of lectures to be given in the Gordon Wilson Amphitheatre of the University
Hospital on December 7, 1950 to the Maryland Academy of General Practice. Lec-
tures are to be given on the following subjects: Diabetes, allergy, antibiotics, sur-
gery, anaesthesia, and pediatrics. A luncheon will be served at the hospital to those
attending. Officers of the Maryland Academy of General Practice are Dr. Charles
F. O'Donnell, Towson, Md., president; Dr. Irving Baumgartner, Oakland, Md.,
secretary-treasurer; and Doctors E. Paul Knotts, Nathan Needle, and B. B. Kneisley,
vice-presidents.
ORTHOPAEDIC RESIDENCY
In a previous issue of the Bulletin, a plan to initiate the training of orthopaedic
surgeons was presented whereby integration of three affiliated hospitals (University,
Baltimore City, and Kernan) was projected. The plan is now in full operation with
a resident orthopaedic surgeon on each staff, serving for one year in rotation. After
3 years in these combined services, the physician will have completed training to
become eligible for examination by the American Board of Orthopaedic Surgery.
The initiation of this training service is a distinctly progressive step in the field of
orthopaedic surgery in Maryland and is of immense satisfaction to us. It adds an-
other link in the cooperative chain of hospitals affiliated with the University of
Maryland.
* Personal letter from the American Medical Association.
ALUMNI ASSOCIATION SECTION
OFFICERS
Louis A. M. Kradse, M.D., President
Vice-Presidents
Samuel E. Enfield, M.D. Randolph M. Nock, M.D. Fred B. Smith. M.D
Thurston R. Adams, M.D., Secretary Simon Brages, M.D., Assistant Secretary
Minette E. Scott, Executive Secretary Charles Reid Edwards, M.D., Treasurer
Board of Directors
William H. Triplett, M.D.
Chairman
Louis A. M. Krause, M.D.
Charles Reid Edwards, M.D.
Thurston R. Adams, M.D.
Simon Brager, M.D.
Austin Wood, M.D.
Wetherbee Fort, M D.
Albert E. Goldstein, M.D.
Daniel J. Pessagno, M.D.
Louis H. Douglass, M.D
Hospital Council
Alfred T. Gundry, M.D.
George F. Sargent, M.D.
Nominating Committee
Frank Ogden, M.D.
Chairman
Robert F. Healy, M.D.
Ernest I. Cornbrooks, M.D.
Frank K. Morris, M.D.
David Tenner, M.D.
Alumni Council
Library Committee
Milton S. Sacks, M.D.
Representatives to General Alumni
Board
John A. Wagner, M.D.
Thurston R. Adams, M.D.
William H. Triplett, M.D.
Representatives, Editorial Board,
Bulletin
Harry C. Hull, M.D.
Albert E. Goldstein, M.D.
Louis A. M. Krause, M.D.
(ex-officio)
Lewis P. Gundry, M.D.
The names listed above are officers for the term beginning July 1, 1950 and ending June 30, 1951.
PROGRESS
It will doubtless be gratifying to our Alumni to know that a continued increase in
facilities for training and service may be noted at almost every visit to the vicinity
of Lombard and Greene Streets. The most recent evidence is the new Psychiatric
unit which is getting well under way in its course of construction.
This structure is located west of the hospital, to which it will be physically at-
tached, and when finished, will give our University complete occupancy of the blo:k
bounded by Greene, Lombard, Penn and Redwood Streets.
We have just reason to be proud of this newest addition, because it will give addi-
tional opportunity, not only for service in a much neglected field, but also training,
according to the newer concepts dealing with mental illness.
The program for full utilization of these new facilities is already in process of
development and since the Department is organized on a full time basis, should be
ready in advance of the completed building.
It not only contemplates broadening the scope of teaching at the undergraduate
level but also post graduate training, which will make possible the forging of a val-
uable link between the teaching of psychiatry and its practice, whether that be in
our state hospital system or privately.
It is well to remember the criticism that has been heaped upon our state mental
hospitals in the recent past. Well trained personnel to staff them is our greatest,
in fact, our only assurance that we shall not be subjected to that ignominy again.
Our Alumni should get behind this program and give it full support to the end that
our mentally ill will have the benefit of services fortified by training and experience
ALUMNI ASSOCIATION SECTION
and the general public the satisfaction that comes from knowing that a job is being
well done.
A chain is only as strong as its weakest link. A school's influence is measured by
the interest shown and the support given by its Alumni. Let us not be the weak
link!
William H. Triplett, M.D., Chairman, Board of Directors
ALUMNI REUNION DATE SET
The annual Alumni Day with reunions, the annual banquet, the presentation of
the annual Alumni Honor Award, and the clinical sessions at the University Hos-
pital will be held on June 7, 1951.
While the April, 1951, Bulletin will contain further details of the program and
special events, attention is called at this early date, so the Alumni might prepare
in advance by including this date on the Spring calendar. You will note this meeting
is in close proximity to the American Medical Association meeting which will be
held at Atlantic City, June 11-15.
Special honors will be bestowed this year on the members of the class of 1901 who
will be presented with their honorary life membership cards and certificates of 50
years of service. The members of the three classes of 1901 are listed below.
Paul Richard Brown
Ashby C. Byers
Richard P. Carman
Homer E. Clarke
George H. Costner
William H. Coulbourn
Benjamin H. Dorsey
Norman S. Dudley
Charles T. Fisher
Charles W. Gardner
Robert McC. Glass
William Clay Abel
David B. Ackley
Harry E. Anthony
Fletcher F. Carman
John R. Davies
George H. Dill
Campbell F. Flautt
Edgar T. Flint
Frank A. Glantz
Louis F. Hamrick
Charles A. Anderson
Jacob A. Beer
J. M. Barry
Lewis Berlin
University of Maryland
Robert Lee Hall
Albert Scott Harden
Frank C. Heath
Edward L. Jones
Guy W. Latimer
Walter T. Messmore
Watson S. Rankin
William M. Riley
William R. Rogers
Thomas S. Tompkins
Edward D. Weems
Baltimore Medical College
Enoch H. Harsh
Eugene H. Hayward
Samuel J. Herman
Myron D. Lipes
James A. McClung
Robert F. Morrison
Lamar C. Oyster
William W. Scarborough
Frederick G. Shaul
Colin R. Weirich
College of Physicians and Surgeons
Philip S. Chancellor
Michael A. Conboy
A. D. Hays
Joshua Hilliard
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Andrew J. Loughman
Stanley T. Lovvry
William E. McCurry
Edwin M. McKay
John B. McMurray
Tunis Nunemaker
Everett M. Pearcy
John R. Robinson
Mervin T. Sudler
S. Dana Sutliff
Andrew B. Vanderbeek
Samuel Weinberg
Edward T. West
Virgil G. Williams
Aside from the 50 year classes, reunions are scheduled for the classes of 1906,
1911, 1916, 1921, 1926, 1931, 1936, 1941, and 1946.
Class secretaries should contact the office of the Executive Secretary, Mrs. Min-
ette E. Scott for complete mailing lists and assistance in planning class reunions.
Dr. Philip Adalman shown with his portrait bust of Dr. Rufus Harti
New York Times
-Photo; Wide World -
ALUMNUS A PRIZE WINNING SCULPTOR
Dr. Philip Adalman, class of 1931, surgeon, of Jackson Heights, New York has
not only maintained his active practice but has continued his hobby of sculpture,
being a member of the Clay Club Art Center since 1936.
Among his many works is included the portrait bust (see illustration) of Dr. Rufus
Hartill, Assistant Superintendent of the (New York) City Public School System,
which took first prize in the Physicians' Art Section of the American Medical Asso-
ciation.
NOMINATION FOR ALUMNI HONOR AWARD— 1951
During the month of February, the Board of Directors of the Alumni Association
will meet to nominate the 1951 candidate for the annual Alumni Honor Award, a
certificate and gold key presented to an outstanding alumnus of the University of
ALUMNI ASSOCIATION SECTION xix
Maryland, Baltimore Medical College or College of Physicians and Surgeons who,
through "outstanding contribution to medicine and service to mankind" has been
deemed worthy of this nomination.
If you know of any alumnus who might merit this nomination, please submit his
name to Dr. Thurston R. Adams, Secretary of the Medical Alumni Association, Uni-
versity Hospital, Baltimore 1, Maryland. All nominations will be given careful
consideration by the Board.
In the past three years the Honor Award has been presented to the following:
W. Wayne Babcock, P & S, class of 1893 — Professor Emeritus of Surgery, Temple
University.
Nolan D. C. Lewis, class of 1914 — Professor of Psychiatry, College of Physicians
and Surgeons, Columbia University.
Arnold D. Tutile, class of 1906, Col., M.C., USA (ret'd)— Medical Director, United
Airlines.
Heads S. & D. Blood Donor Center
Dr. Robert E. Bauer, class of 1946, has been named Medical Director of the Sharp
and Dohme Blood Donor Center, 702 E. Baltimore Street, Baltimore. This announce-
ment was made recently by Dr. J. E. Schneider, Director of Biologic and Sterile
Pharmaceutic Production.
A graduate of Johns Hopkins University in 1943, Dr. Bauer received his doc-
torate from the University of Maryland School of Medicine in 1946 and served his
internship from 1946-47 at the University Hospital, Baltimore.
From 1947-48 he was Assistant Resident at the same hospital and from 1948-49
he served in two capacities — as Plant Physician at the Glenn L. Martin Company
in Baltimore and Assistant in Pathology at the University of Maryland School of
Medicine. He completed his Residency in Medicine at the University Hospital July 1,
1950.
CORRESPONDENCE
September 4, 1950.
Just received the July Bulletin and must say I enjoy it very much. I note with
regret that Dr. Frank Crouch has passed away, as well as Dr. Thomas Tierney and
Dr. Lloyd Noland. The latter played on the football team with me at B.M.C. in
1899 and 1900. 1 graduated from B.M.C. with the class of 1901 and next year I want
to go back to Baltimore and see if any of the old boys are still living. I retired four
years ago and have not been in very good health since but hope to be able to make
the trip at the next graduation.
In view of this, may I ask if there will be any celebration for the 50 year men and
when? Dr. Harry Anthony of Moravia, New York will probably join me at the time,
as he was in my class.
Another thing, I have tried to find out is about my old fraternity. I was a charter
member of Phi Chi and I believe this fraternity has since affiliated with some other
fraternity. Can you tell me if this is correct and if the fraternity is still at the Univer-
sity of Maryland? I see that my old professor, Dr. Rowland, is still living and would
like to write him but do not know where to write him. Can you give me his address?
xx BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
I know it is a long time before Spring but I want something to look forward to.
It is asking a good deal for me to expect people as busy as you all are to write me
but I am very anxious to get these things cleared up.
Thanking you in advance, I am
Very fraternally yours,
M. D. Lipes, class of 1901 B.M.C.
June 7, 1950.
"Thank you" and "appreciate" are inadequate expressions of my feelings regard-
ing the handsome Fifty Year Certificate.
Such a gesture is a grand one. The Alumni's thoughtfulness means a great deal to
me personally and I am sure it does to all of us who have been privileged to remain
active and serve humanity for five decades.
With every good wish, believe me
Sincerely yours,
Isaac C. Dickson, class of 1897
3055. West North Avenue,
Baltimore, Maryland
May 29, 1950.
Gentlemen:
Enclosed is my check for $5.00 for next year's dues. I would like to express my
admiration for the fine job that has been done with the Bulletin.
Sincerely yours,
William I. Wolff, Class of 1940
2 Horatio Street
New York 14 New York
May 23, 1950.
Will you please convey to the officers of the Association my thanks for the fifty
year Alumni certificate received by me a few days ago. I prize it greatly and shall
always appreciate having received it.
I retired from active practice the first of the present month but shall always be
interested in the progress of my Alma Mater.
Sincerely yours,
Richard J. Turk, Class of 1898, B.M.C.
May 20, 1950.
Allow me to thank you for the beautiful and attractive certificate you sent me
several weeks ago. I appreciate it very much. Please convey to the other members of
your committee my thanks.
With kindest regards and best wishes, I am
Yours sincerely,
R. W. Love, Class of 1897, B.M.C.
Moorefield, Virginia
ALUMNI ASSOCIATION SECTION
ITEMS
Dr. Kenneth L. Zierler, class of 1941, is now serving as Assistant Professor of
Environmental Medicine at Johns Hopkins School of Hygiene and Public Health
in Baltimore. Dr. Zierler recently reported on his work concerning the effects of vita-
min E on the carbohydrate metabolism of muscle.
Dr. C. G. Warner, class of 1928, Pathologist at the Baltimore City Hospitals,
was recently elected Vice-president of the Maryland Society of Pathologists.
Dr. Frank Ayd, Jr., class of 1945, was recently the speaker at the Detroit (Michi-
gan) First Friday Club.
Dr. Wilbur S. Brooks, class of 1938, is now Chief Radiologist at the University
of Syracuse, Syracuse, New York.
Dr. Donald E. Fisher, class of 1947, until recently an Associate in Pathology
at the School of Medicine, has been commissioned in the United States Public
Health Service and assigned to the Communicable Disease Center at Chamblee,
Georgia.
MAYO CLINIC APPOINTMENTS
Dr. James S. Hunter, Jr., class of 1941, who recently completed his Fellowship
in Gynecology and Obstetrics at the Mayo Clinic has been certified by the American
Board of Obstetrics and Gynecology. Dr. Hunter has been appointed to the staff of
the Mayo Clinic in the section on Obstetrics and Gynecology.
Dr. John Spittell, class of 1949, now Assistant Resident in Medicine at Mercy
Hospital, Baltimore, has been appointed Fellow in Medicine at Mayo Clinic, effec-
tive July 1, 1951.
APPOINTED ASSISTANT PROFESSOR AT CORNELL
Dr. Aaron Feder, class of 1938, has recently been appointed Assistant Professor
of Clinical Medicine at the Cornell University Medical College.
Dr. R. Adams Cowley, class of 1944, is now in his second year as Senior Clinical
Instructor in the Department of Thoracic Surgery at University Hospital, Ann
Arbor, Michigan.
Dr. Maurice Feldman, Jr., class of 1944, was one of the speakers at the 15th
Annual Convention of the National Gastroenterological Association held at the
Hotel Statler, New York City, June 9 to 11, 1950.
Dr. James Stanley Hunter, class of 1941, was recently awarded the degree of
Master of Science in Obstetrics and Gynecology at the Commencement exercises of
the University of Minnesota.
xxii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Dr. Walter Stevenson, class of 1906, B.M.C., of Quincy, Illinois, President of the
Illinois State Medical Society, was the author of a paper entitled The Practice of
Medicine — A Priceless Heritage, delivered at the annual meeting of the Illinois State
Medical Society at Springfield, Illinois on May 23, 1950 and published in the Illinois
Medical Journal June, 1950.
Dr. Raymond C. V. Robinson, class of 1940, was recently awarded the degree of
Master of Medical Science at the University of Pennsylvania.
Dr. Robert Gardner, class of 1947, has been appointed to a three year residency
at Dr. Cole's Clinic in Cleveland.
Dr. Robert C. Duvall, Jr. class of 1947, formerly of the Department of Derma-
tology at the School of Medicine has recently been appointed to the Department of
Pathology at the University of Tennessee School of Medicine.
Dr. George C. Rogers, class of 1943, is now engaged in the practice of Gynecology
and Obstetrics at 1 Catawba Street, Spartanburg, South Carolina.
Dr. William H. Triplett, past President and present Chairman of the Board of
Directors of the Medical Alumni Association has recently been named President of
the 29th Division Association.
Dr. J. Morris Reese, Associate Professor of Obstetrics was recently elected District
Governor of the 267th District Rotary International. On June 21, 1950, Dr. Reese
conducted a Panel Discussion on Medicine at the District Rotary International
Convention which was attended by medical representatives from all over the world.
FRATERNAL NEWS SECTION
NU SIGMA NU
The Spring formal dance will be held in the ballroom
of the Stafford Hotel, Charles and Madison Streets,
Baltimore on April 7, 1951, beginning at 9 P.M.
A series of smokers designed as an orientation course
for new medical students has been in progress during
the year. Members of the Alumni including Drs.
Mech, Wagner, Savage and Hull have addressed the
group.
ANNUAL ALUMNI BANQUET
The annual Alumni banquet of Nu Signa Nu will be held on February 18, 1951
at the Nu Signa Nu House, 922 St. Paul Street, Baltimore. Note this date on your
calendar. Details will follow.
For his work in the use of cortisone in rheumatoid arthritis, Dr. Philip S. Hench
of the Mayo Clinic, Rochester, Minnesota was recently awarded the 1950 Nobel
prize for medicine. Dr. Hench is a member of Nu Sigma Nu. Dr. Erland H. Hed-
rick, class of 1917, is now serving his third term in Congress as the Representative
of the Sixth District of West Virginia. Dr. Raymond J. Dempsey, class of 1948 is
now in his Residency in Dermatology at the University Hospital, Ann Arbor, Michi-
gan. Dr. Norman T. Kirk, class of 1910 is at present residing at Montauk, N. Y.
PHI BETA PI
The year 1951 marks the first year since 1940 that a Phi
Beta Pi has graduated from the School of Medicine. The active
membership of the Chapter has now grown to 30, with 25 new
pledges awaiting initiation.
Dr. Eduard Uhlenhuth, Professor of Anatomy, was the
speaker at the opening smoker, his topic being "The Purpose
of a Medical Fraternity."
Plans for the future include two smokers, details of which
will be announced by letter. The open forums conducted last
year will be continued.
The Chapter has organized a library which is slowly growing. Alumni of Phi Beta
Pi are solicited for contributions of books and journals. The Chapter also solicits
donations of furniture for the Chapter Rooms or donations earmarked for that pur-
pose. Remember the mailing address of Phi Beta Pi is care, the school of Medicine.
All inquiries will be promptly acknowledged.
OBITUARIES
DR. ELMER CLAY KEFAUVER
Dr. Elmer Clay Kefauver, class of 1891, died July 27, 1950 at the Frederick
Memorial Hospital, Frederick, Maryland, of heart disease, aged 82.
He was born at the old Kefauver homestead in Middletown Valley, Maryland,
the son of Richard C. and Laura Toms Kefauver.
He attended the old Middletown Academy and later graduated from Franklin
and Marshall College. After his graduation he began studying under the late Dr.
J. E. Beatty and then entered the University of Maryland School of Medicine
graduating in 1891.
Soon after his graduation he entered practice at Thurmont, Maryland, remaining
until 1923 when he was made County Health Officer for Frederick County (Mary-
land). In this capacity he served for 24 years, 23 of them also as Health Officer of the
city of Frederick. He retired from both appointments in 1947.
In 1892 he married Miss Mary Alice Atlee. Always active in politics and fraternal
affairs, for a number of years he was a member of the Frederick County Board of
Education.
DR. EDWARD DORSEY ELLIS
Dr. Edward Dorsey Ellis, B.M.C., class of 1890, aged 81, died in Baltimore on
June 22, 1950.
OBITUARIES xxv
The son of John and Emma Ellis, he received his education in the public schools
of Baltimore and following his graduation from Medical School continued his studies
at the Johns Hopkins Medical School, then entered practice with his uncle Dr.
R. H. P. Ellis. He continued in general practice for over 25 years retiring in 1910.
DR. HERMAN B. SHEFFIELD
Dr. Herman B. Sheffield, class of 1895, aged 79, died on March 17, 1950 of arterio-
sclerosis.
Following his graduation from Medical School he became associated with the
Yorkville Dispensary and Hospital for Women and Children from 1898 to 1912,
along with several additional hospital appointments. In 1905 he was appointed In-
structor in Diseases of Children at the New York Post Graduate Hospital. Dr.
Sheffield was a Fellow of the New York Academy of Medicine and a member of the
American Medical Association and New York State Medical Society. He was a
founder of the Zeta Beta Tau Fraternity and was the author of five books on diseases
of children including two text books. In 1914 he won the Alverengo prize of the College
of Physicians of Philadelphia and in 1920 the Merritt H. Cash prize of the New
York State Medical Society. In 1 930 he retired from practice because of failing vision
but continued his literary activities with the writing of lyric poetry.
DR. HARRY GALLISON PRENTISS
Dr. Harry Gallison Prentiss, class of 1881, died at his home in Baltimore on No-
vember 24, 1950, aged 92. He was born in Baltimore on May 2, 1858. After his gradu-
ation from the School of Medicine, he began the practice of general medicine in the
Waverly-Govans area and continued his active participation in medical affairs up
until a few years ago.
Dr. Prentiss was one of the few living physicians who began his career on horseback
and saw the evolution of many of the milestones in medical science
Brown, Edward W., Washington, Va.; P & S, class of 1887; aged 90; died, July 2,
1950.
Burns, Robert Francis, Fitchburg, Mass.; B.M.C., class of 1908; aged 66; died, June
5, 1950, of coronary disease.
Cannon, Martin Loeb, Washington, D. C; class of 1932; aged 48; died, June 26,
1950, of coronary disease.
Carter, Paul Conway, Madison, N. C; class of 1916; aged 60; served during World
Wars I and II; died, March 27, 1950, of hepatitis.
Devlin, Peter C, Lynn, Mass.; B.M.C., class of 1902; aged 72; died, July 25, 1950,
of coronary thrombosis.
Dunlap, William Verner, St. Petersburg, Fla.; P & S, class of 1897; aged 75; died,
June 5, 1950, of cerebral thrombosis.
Ewald, George Latrobe, Baltimore, Md.; class of 1900; aged 75; died, July 14, 1950.
Fleming, Thomas F., Exeter, Pa.; B.M.C., class of 1901; aged 76; died, May 6, 1950,
of cerebral hemorrhage.
Fox, Lorah O., Ansted, W. Va.; P & S, class of 1910; aged 60; died, July 6, 1950, of
heart disease.
xxvi BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Glidden, Edson W., Worcester, Mass.; class of 1907; aged 65; served during World
War I; died, April 26, 1950, of coronary occlusion.
Gore, Michael Alvord, Granby, Colo.; class of 1918; aged 56; died, April 10, 1950.
Harper, James Clarence, Greenwood, S. C.; class of 1902; aged 77; died, July 17,
1950.
Hart, Henry D., Genesee, Pa.; B.M.C., class of 1893; aged 89; died, April 18, 1950,
of cerebral hemorrhage.
Hines, Frank Brown, Chestertown, Md.; P & S, class of 1904; aged 68; served during
World War I; died, March 28, 1950, of carcinoma of the right lung.
Hood, M. Bowman, Baltimore, Md.; B.M.C., class of 1900; aged 72; died, May 13,
1950, of heart disease.
Iseman, Everett, Savannah, Ga.; class of 1909; aged 65; served during World War
T; died, September 3, 1950, of coronary thrombosis.
Jefferson, Benjamin Lafayette, Grand Junction, Colo.; class of 1893; aged 78; died,
July 21, 1950.
Kefauver, Elmer C, Frederick, Md.; class of 1891; aged 82; died, July 7, 1950.
Kelly, Clyde Ernest, Vandergrift, Pa.; class of 1929; aged 49; died, August 30, 1950,
of heart failure.
King, Isaac Newton, Prince Frederick, Md.; B.M.C., class of 1897; aged 76; died,
June 25, 1950, of carcinoma.
Kipps, David M., Front Royal, Ya.; P & S, class of 1888; aged 84; died, August
17, 1950, of coronary thrombosis.
Kisner, Jacob C, Albuquerque, N. Mex.; P & S, class of 1880; aged 96; died, July
4, 1950.
Lanich, Lloyd Jackson, Kingwood, W. Va. ; class of 1915; aged 63; served during
World War T; died, June 27, 1950, of cerebral hemorrhage.
LaValle, Irving Howard, Fish's Eddy, N. Y.; B.M.C., class of 1913; aged 68; died,
August 17, 1950, of carcinoma of the lungs.
Lavoie, Zenon Annable, Manchester, N. H.; B.M.C., class of 1902; aged 78; died,
June 1, 1950, of gangrene of the leg, popliteal aneurysm and general arterio-
sclerosis.
Law, Thomas F., Washington, D. C, P & S, class of 1906; aged 71; died, June 30,
1950, of cerebral hemorrhage.
Lightle, William E., North Berwick, Me.; B.M.C., class of 1894; aged 82; died, May
1, 1950, of cerebral hemorrhage.
McKee, John Sasser, Raleigh, N. C; class of 1907; aged 72; served during World
War I; died, April 22, 1950, of coronary occlusion.
Norton, James Arthur, Conway, S. C; class of 1903; aged 73; served during World
War I; died, July 21, 1950, of carcinoma.
Perkins, Thornton W., Hopkinsville, Ky.; P & S, class of 1900; aged 80; died, April
10, 1950, of carcinoma of the prostate.
Reichard, Lewis Nyman, Brownsville, Pa.; P & S, class of 1899; aged 73; died, May
15, 1950, of embolism and heart disease.
Richardson, Walter B., Heathsville, Ya.; B.M.C., class of 1895; aged 82; died, Au-
gust 17, 1950, of carcinoma of the prostate.
I OBITUARIES xxvii
Robinson, Francis A., Burlington, Mass.; B.M.C., class of 1894; aged 81; died,
April 29, 1950, of heart disease.
Smith, Edward Sanborn, Kirkville, Mo.; class of 1900; aged 75; served during World
War I; died, July 23, 1950, of cerebral hemorrhage.
Spalding, William Cullen, Los Angeles, Calif.; P & S, class of 1915; aged 60; died,
I May 23, 1950, of coronary occlusion.
Van Poole, Gideon McDonald, Honolulu, Hawaii; class of 1899; aged 73; served
during World War I; died, April 13, 1950, of carcinoma of the prostate.
Ward, Jesse Elliott, Robersonville, N. C; class of 1904; aged 67; died, March 23,
1950, of acute heart failure.
Warren, David Edward, Passaic, N. J.; P & S, class of 1892; aged 81; died, July
S 14, 1950.
Welland, Herman, Rockbridge Baths, Va.; class of 1899; aged 78; died, February
I 28, 1950.
Whitaker, Preston W., Long Beach, Calif.; P & S, class of 1908; aged 65; died, re-
cently, of heart disease and cerebral hemorrhage.
Wood, Frederick Barton, Elmhurst, N. Y.; B.M.C., class of 1910; aged 67; died,
June 24, 1950, of heart disease.
Special Notice on first page of Alumni Section
Bulletin of
THE SCHOOL OF MEDICINE
UNIVERSITY OF MARYLAND
VOLUME 36 April, 1951 NUMBER 2
EDITORIAL
A DOCTOR'S DUTY
During the past twenty years the average entering medical class has numbered
6,241. The average graduating class has numbered 5,230. The average loss from
each class has been 1,011. This gives an attrition rate through the four years of
medical college of 16.3 per cent. With a current ratio of about one physician for
every 760 persons but with admitted difficulties arising from unequal distribution
and continued calls from the Armed Forces for medical personnel, it has been sug-
gested that the total number of medical graduates should be materially increased
through the establishment of new schools of medicine.
Instead of increasing the facilities for students of medicine, it is the opinion of
many that a more careful survey of the candidates for admission to schools of medi-
cine, with a resulting lower attrition rate, could increase the number of graduates
by 750 a year. Consequently, medical educators have turned to the task of ade-
quately screening the large number of applicants, selecting those men and women who
are not alone properly qualified but who are oriented to the study of medicine and
whose college recommendations indicate a high degree of sincerity and motivation.
This is a tiresome, expensive, and consuming task. However, it produces results.
The University of Maryland is taking steps to lower this national attrition rate.
This will mean fewer empty seats in class as a result of failure or withdrawal. This
means more doctors; more competent doctors.
The physician's duty to medical education is the recognition and careful guidance
of competent and purposeful young people during their early education. This is
particularly applicable to the doctor's son, who, desiring to emulate his father, often
decides to enter the practice of medicine. Only too often the disappointed alumnus
is confronted by a knowledge that his efforts to guide his son have been instituted
too late. Many college faculties have already organized premedical committees who
will advise students during their college years. The doctor's son finds himself in a
most fortunate position, having the advice and experience of a father who has
devoted his life to the practice of medicine. It is therefore prudent that every phy-
sician who has a son who aspires to follow in his footsteps, begin early to inquire into
the most minute details of his education by consulting the premedical committee of
the college where his son will attend, and by securing a copy of the medical school
catalogue to learn its requirements at the same time.
Continued careful attention to these details will not only assure a supply of
competent physicians but will assist those doctors whose sons would follow them
in the practice of medicine.
47
SUGAR .ALCOHOLS— XXVIII. TOXICOLOGIC, PHARMACODYNAMIC AND
CLINICAL OBSERVATIONS ON TWEEN 80*
JOHN C. KRANTZ, JR., Ph.D.,1 PERRY J. CULVER, M.D.,2 C. JELLEFF CARR, Ph.D.1
and CHESTER M. JONES, M.D., F.A.C.P.2
INTRODUCTION
Malnutrition associated with steatorrhea and a faulty absorption of such fat
soluble substances as Vitamins A and K has been observed in a number of patients
with gastro-intestinal tract diseases, such as sprue, pancreatic deficiency, regional
ileitis, after short-circuiting operations on the small bowel, and following subtotal
gastrectomy. Restoration of an adequate state of nutrition in these patients often
taxes the ingenuity and pharmacopeia of the clinician. The magnitude of the loss
of caloric material in the stools of these patients is illustrated by the fact that;
whereas, the normal stool fat content is usually less than 4 per cent of ingested fats
(1), under these disease conditions the fecal lipid content may exceed 40 to 60 per
cent of the dietary intake of fat (2).
Jones et al. (3) have shown that the administration of the emulsifying agent Tween
80 to such patients may produce a dramatic increase in the intestinal absorption of
fat and vitamin A. Holt has observed a similar effect of Tween 80 in premature in-
fants (4). Improvement in the absorption of vitamin A by means of the corresponding
laurate or palmitate (Tween 20 or 40) has been reported by Sobel et al. (5) and by
May and Lowe (6), although Johnson et al. (7) found the laurate to have no signi-
ficant effect on fat absorption in low concentrations. Becker et al. (8, 9) have indi-
cated that Tween 80 may have an effect upon blood chylomicron curves in man.
In consideration of the possible clinical implications of Tween 80, a survey of our
knowledge of the toxicology and pharmacodynamics of this emulsifying agent is
presented.
THE CHEMICAL AND PHYSICAL NATURE OF TWEEN 80
Tween 80 is a complex mixture obtained by the rigidly controlled reaction of 20
mols of ethylene oxide with 1 mol of mixed sorbitan oleates, which are in turn the
products of the partial esterification of the hexahydric sugar alcohol sorbitol with
oleic acid. Its typical component is represented by the formula top of page 49.
It is a lemon to amber-colored viscous liquid, having a faint characteristic odor
and bitter taste, and forms practically neutral solutions with all proportions of
water. It is also soluble in alcohol, fats, and vegetable oils, but is insoluble in mineral
oil.
* These studies were aided by grants from Atlas Powder Company, Wilmington, Delaware. Tween
80 is the Atlas trade-mark for polyoxyethylene (20) sorbitan monooleate. This compound is listed,
in U.S.P. XIV under the name "Polysorbate 80" and is designated "Sorethytan (20) Monooleate"
by the Council on Pharmacy and Chemistry of the A.M.A.
1 Department of Pharmacology, School of Medicine, F/niversity of Maryland, Baltimore, Mary-
land.
2 Department of Medicine, Harvard F/niversity, and the Medical Service of the Massachusetts
General Hospital, Boston, Mass.
48
KRANTZ, ET AL.— SUGAR ALCOHOLS
49
H
O
H
H H
C-
c-
-C— 0— (CH2— CH2— 0)x— H
-C— 0— (CH2— CH2— 0)y— H
H
H— C— 0— (CH2— CH2— 0)— H
O
Ho C — 0 — C — C 1 7H34
where the sum of x + y + z equals an average total of 20.
As a partial ester of a fatty acid and a strongly hydrophilic polyhydric alcohol
derivative, Tween 80 is an emulsifying agent and a non-ionic surface active agent;
a 0.1 per cent solution in water at 25 C. having an interfacial tension of 41 dynes/ cm.
against air and 8.7 dynes/cm. against a sample of corn oil, compared with 72 and 19.4
dynes/cm. respectively for distilled water (10, 11).
EFFECT OF LIPASE
Being a fatty acid ester, Tween 80 is readily hydrolyzed by pancreatic lipase to
oleic acid and the corresponding polyoxyethylene sorbitan alcohols. Harrisson (12)
has shown the rate of lipolysis of this compound to be approximately one-half that
found for olive oil, in agreement with the data obtained by Gomori (13) on Tweens
40 and 60, the respective polyoxyethylene sorbitan palmitates and stearates. Simi-
larly, Archibald (14) has proposed the corresponding laurate as the substrate for the
determination of lipase activity.
TOXICOLOGY IN ANIMALS
Extensive feeding studies in animals have been made with all members of the
Tween group by Krantz and Carr (11). Among these, they have shown Tween 80 to
be innocuous for white rats in concentrations of two per cent in their diet for their
life span, as shown in the accompanying table. Groups of 30 white rats were fed a
similar concentration of this emulsifying agent through three generations, according
to the procedure of Carr and Krantz (15). There was no evidence of alteration in the
fecundity of the first and second generation of rats. The growth patterns of the
animals in the first, second, and third generations were not significantly affected.
There was no evidence of gross or histologic damage to the livers and kidneys of rats
fed Tween 80 in the three generations. Likewise, the feeding of 1 gram per day to
two Macacus rhesus monkeys for 10 months produced no significant histologic
visceral changes.
Acute toxicity studies were also conducted on the white rats (11). Animals weigh-
ing from 120 to 200 grams tolerated Tween 80 orally in doses of
symptoms. When these animals were sacrificed three days late
It'*
^
LIBRARY °
Feucdad 1813
%
OL
OF M
&o\L
r\\
50
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
liver showed no damage. Injected intraperitoneally in undiluted form, the compound
killed by respiratory paralysis. The LD50 intraperitoneally for the white rat is
between 8 and 9 cc. per kilogram of body weight. Hopper and coworkers (16) have
reported the LD50 for Tween 80 in mice to be greater than 25.0 gms. per kilogram
(per os, 72 hours observation) and 5.8 gm./Kg. via intravenous injection (24
hours observation).
In experiments with mice fed 1 per cent of Tween 80 over a two-month period,
Dubos (17) reported that the addition of the emulsifier to the basal diet did not
affect the weight, mortality and susceptibility of the animals to experimental tuber-
culosis, or to the therapeutic effects of penicillin after the experimental infection.
Kellner et al. (18) fed rabbits 10 cc. of Tween 80 daily for 20 weeks and injected
unspecified amounts intravenously for 8 to 14 weeks (19) with apparently no unto-
ward effects.
TABLE 1
Summary of Life Span (2-year) Study of White Rats Fed 2% of Tween 80 in a Basal
Diet of Purina Chow
NUMBER OF ANIMALS
At start
Autopsied in progress. . .
Accidental deaths
Net carried
Cause of deaths
a. Unknown
b. Middle ear infection
Surviving at 24 months. .
Surviving at 24 months, c
Survivors autopsied
EXPERIMENTAL
Male Female Total
15
4
1
10
5
2
3
30
3
15
3
2
10
6
1
3
30
3
30
7
3
20
11
3
6
30
6
Male Female Total
15
2
1
12
7
4
1
15
1
1
13
6
4
3
23
3
30
3
2
25
15
8
4
16
4
EFFECT ON BLOOD PRESSURE
Of special interest is the depressing effect of intravenously administered Tween
80 upon the blood pressure, an effect which varies from species to species (20).
When a 5 per cent aqueous solution of this emulsifier is injected in doses of 1 cc. per
kilogram of body weight into the veins of cats, rabbits, and Macacus rhesus monkeys,
there is a slight and transient fall in blood pressure. On the other hand, dogs and
other canine species (21) exhibit an idiosyncratic reaction to intravenous Tween 80
by a prolonged depressor response. This fall in blood pressure was never elicited
by the oral administration of the Tween emulsifiers. Moreover, when only the
polyoxyethylene sorbitan portion of the ester obtained by saponification was in-
jected intravenously, there was no depressor response even in the dog. This would
seem to indicate that the whole Tween molecule is necessary for any effect upon
blood pressure. The idiosyncratic response of the canine family to the intravenous
administration of all members of the Tween group, regardless of the nature of the
esterifying fatty acid, appears to be caused by the release of some histamine-like
substance (20, 22, 23). The reaction has not been obtained in man (20).
KRANTZ, ET AL— SUGAR ALCOHOLS 51
EFFECT ON BLOOD CELLS
Tween 80, in common with other surface active agents, may be shown in vitro
to have some hemolytic effect, as follows:
The freshly shed, defibrinated blood of the dog ^as used. Solutions of the sub-
stance in various concentrations in physiological salt solution were prepared. To 10
cc. volumes of these solutions, 0.1 cc. blood was added, mixed, and observed at 37°
and 26°C, respectively. The results are shown in Table 2.
CLINICAL OBSERVATION AND PHARMACODYNAMICS IN MAN
Evidence of beneficial effects of Tween 80 upon the intestinal absorption of fat and
vitamin A in some cases (3) has prompted two of the authors (C. M. J. and P. J. C.)
to prescribe this emulsifying agent to more than 100 patients at the Massachusetts
General Hospital during the last 4 years. This group of patients, of approximately
equal sex distribution and ranging in age from 5 to 72 years, consists of 10 subjects
who have taken Tween 80 for 3-4 years, 17 for 2-3 years, 19 for 1-2 years, and the
remainder for less than 1 year. The usual dose of Tween 80 has been 4.5 to 6 grams
per day; one man was given 15.0 grams per day for several months. The large body of
clinical and laboratory data collected during the course of the study clearly indicates
the harmlessness of Tween 80 in the human upon continued oral ingestion of the
prescribed amounts.
Clinical observations of these patients during hospitalization or at periodic office
visits demonstrated a complete absence of toxic symptoms referable to the digestive
or urinary systems. A rare patient had an occasional soft stool. Inquiry as to the
presence of other possible symptoms showed a complete lack of headache, dizziness,
muscular or joint aches, itching, weakness, cardiovascular complaints, loss of ap-
petite, or any other manifestation that could be attributed to the ingestion of Tween
80. Blood pressures remained unchanged. In no case was there a significant loss of
body weight, while many malnourished patients gained weight during the period of
continued consumption of the emulsifying agent.
Routine laboratory tests showed that there was no detrimental effect upon the
hematopoetic system. Kidney functions remained normal according to periodic
examinations of the urine. The concentrating powers of the kidneys remained un-
impaired. In no case was there albuminuria resulting from the administration of
Tween 80, and. the absence of formed elements in urinary sediments was evidence of
a lack of irritation of the kidney parenchyma by this substance. There were no in-
creases in the blood non protein nitrogen. Repeated batteries of liver function tests,
including the cephalin flocculation, prothrombin time, bromsulfalein retention, and
serum albumin and globulin levels showed that the emulsifying agent did not disturb
the functions of the liver. Blood calcium levels remained normal or increased from a
low level, and the blood phosphorus levels remained normal.
Of considerable interest is the fact that during this 4 year period of Tween 80
administration, the blood cholesterol levels have shown no significant increase be-
yond the normal range. The blood vitamin A levels also remained within the normal
range, or rose to a normal level if they were initially below normal. The following
case report is representative of the group of patients who have ingested Tween 80
for long periods of time:
52
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Mrs. R. W., a 37 year old widow, had a partial resection of the small and large
bowel in 1942 because of ileocolitis. Following operation, there was diarrhea and
gradually increasing malnutrition. Her weight dropped from a normal of 53 Kg. in
1942 to 38.8 Kg. in March, 1947. On March 12, 1947, the patient began to take 1.5
gm. Tween 80 with her meals for one month. The administration of the emulsifying
agent was discontinued for one month and then resumed on May 27, 1947, at a 3.0
gm. level for one month. It was again discontinued for the following month and
resumed on July 25, 1947, with a daily dose of 4.5 gms. The patient has continued
to take either 4.5 or 6 grams of Tween 80 per day ever since with the exception of an
TABLE 2
Hemolysis Studies
MINUTES FOR 90% HEMOLYSIS
TWEEN 80%
37°C
26°C
10
33
59
5
46
80
1
76
100
0.1
105
270
0.01
none
none
TABLE 3
Urine and Blood Examinations
URINE
BLOOD
Sp. Grav.
Alb.
Sugar
Sed.
NPN
mgms. %
Hgb.
gms. %
WBC
3/ 7/47*
1.026
0
0
0
25
9.3
4.100
9/25/47
—
—
—
—
—
12.6
5,450
12/18/47
1.032
0
0
0
19
—
6,100
5/27/48
1.028
0
0
occ. WBC
15
13.0
—
10/13/48
1.020
0
0
rare WBC
22
14.8
13,100
12/20/49
—
—
—
—
24
—
—
2/17/50
1.018
0
0
0
—
13.0
9,400
10/31/50
—
—
—
—
20
13.0
9,000
occasional control month, during 1948 and without interruption during the past two
years.
At periodic clinic visits she reported gradual improvement in her health during
this time. Her troublesome diarrhea decreased greatly. At intervals, the patient
reported dizzy spells, headaches, belching, vomiting, poor appetite, and occasional
abdominal cramps. These symptoms were present before administration of Tween
80 and appeared as frequently during the intervals that the patient was not taking
the emulsifier as when she was. The appearance of these symptoms was usually as-
sociated with emotional upsets or physical fatigue and could in no way be attributed
to the ingestion of the emulsifier. There were no other symptoms which might suggest
a deleterious effect.
KRANTZ, ET AL — SUGAR ALCOHOLS
53
Physical examinations have shown improvement in weight from a low of 38.8
Kg. in 1947 to 49 Kg. in December, 1950. There has been elimination of the signs of
malnutrition. Her blood pressures have remained normal, being 110 millimeters of
mercury systolic and 70 millimeters, diastolic, in December, 1950. General physical
findings are now normal except for a tender spot in the left lower abdomen. This
tenderness has always been present since the onset of her illness.
The patient's laboratory data, summarized in the following tables, indicate that
Tween 80 has had no deleterious effect upon the liver, kidneys, or blood, and that the
blood chemistries showed no evidence of pathologic variation.
TABLE 4
Liver Chemistries
DATE
CEPH. FLOC.
PROTHROMBIN
TIME
BSP
ALBUMIN
GLOBULIN
per cent
per cent
3/ 7/47*
Neg..
16/16
■ —
3.5
2.0
6/24/47
—
—
—
4.5
2.3
9/25/47
Neg.
17/17
—
4.7
2.1
12/18/47
Neg.
17/16
6%
4.2
2.3
5/27/48
. Neg.
20/17
—
4.2
2.0
10/13/48
Neg.
20/16
—
4.1
2.8
12/20/49
Neg.
17/18
—
4.6
2.1
10/31/50
Neg.
18/19
2%
4.2
2.6
TABLE 5
Miscellaneous Blood Chemistries
DATE
VIT. A
CAROTENE
CHOLEST.
CHOLEST. ESTERS
ca
p
l.V.I cc.
I.U./cc.
mgs.%
mgms.%
mgms.%
mgms.%
3/ 7/47*
0.8
0.6
—
—
8.3
3.7
6/24/47
1.2
0.6
133
94
8.2
3.3
12/18/47
0.6
0.5
130
104
8.0
3.7
5/27/48 -
0.6
0.6
153
84
8.0
3.6
10/13/48
1.3
0.6
188
108
9.4
3.6
12/20/49
—
—
166
116
9.4
—
10/31/50
0.7
0.4
135
85
8.8
3.0
* Before administration of Tween 80.
In addition to the above described clinical and laboratory observations, special
studies were carried out on a few patients to see if Tween 80 might produce other
measurable changes in man. Five persons, who were on constant daily food intakes
in the metabolic ward, were subjected to metabolism tests before and during the
administration of the emulsifying agent. There was no evidence of alteration in
metabolic rate as a result of the taking of Tween 80. Table 6 shows the metabolic
rates in a typical case.
An attempt was also made to obtain information about the absorption and utili-
zation of water soluble vitamins while patients were ingesting Tween 80. Indirect
evidence of no effect was obtained by determining the urinary excretion of water
54
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
soluble vitamins before and during the administration of the emulsifying agent to 9
persons who were receiving a constant food and vitamin intake while in our metabolic
ward. The findings in a typical case are shown in Table 7.
FATE OF TWEEN 80 IN MAN
It has been possible to determine the ethoxyl value of the urine and stools of the
subjects fed Tween 80 and thereby to ascertain the amount excreted of at least the
TABLE 6
Metabolic Rates in Case D. D., 48 year old female
2/26/48
BEFORE TWEEN 80
4/22/48
during administration tween 80,
(6.0 gms./day)
7 a.m.
10 a.m.
2 p.m.
4 p.m.
-20
-3
+3
+ 7
-25
+4
-3
+ 7
TABLE 7
The Urinary Excretion of Water Soluble Vitamins Before and During the Administration of Tween 80
4.5 grams per day, to a 61 year old man
PERIOD
URINARY EXCRETION IN PER CENT OF INTAKE
Thiamin
Riboflavin
Niacin
Ascorbic Acid
Before
During
9.6
11.3
23.7
30.3
31.4
46.2
21.6
30.9
TABLE 8
Experimental Recovery of the Polyoxyethylene Moiety from the Urine and Stools of Four Subjects
SUBJECT*
FEEDING PERIOD
% EXCRETED IN
POST-FEEDING PERIOD
% EXCRETED IN
TOTAL
EXCRETION
Urine
Stool
Urine
Stool
R. S
F. V
3.8
4.0
3.8
5.8
85.0
80.3
80.6
83.4
0.1
0.1
0.1
0.1
8.9
13.4
17.8
7.0
%
97.8
97.8
D. D
102.3
E. R
96.3
* Each ingested 54 gms. of Tween 80 during a 12-day period.
polyoxyethylene portion of the polyoxyethylene sorbitan moiety from the Tween 80
ingested. Details of this study will be reported elsewhere (24). The data summarized
in Table 8 show that, within the limits of error of the chemical method of analysis,
there has been complete excretion of the polyoxyethylene groups from the human
body.
Qualitative analysis of the urine failed to show the presence of any fatty acid.
KIL4NTZ, ET AL— SUGAR ALCOHOLS 55
This fact plus the in vitro evidence of hydrolysis of polyoxyethylene sorbitan mono-
oleate (Tween 80) by pancreatic lipase suggests that the small percentage of the
polyoxyethylene groups excreted in the urine results from hydrolysis of Tween 80
in the intestine and the subsequent absorption of a small amount of the hydrolysate,
with the remaining approximately 95 per cent of the polyoxyethylene moiety ac-
counted for in the stool.
SUMMARY
1. The chemical, physical, and certain biochemical properties of the non-ionic
emulsifying agent polyoxyethylene (20) sorbitan monooleate (Tween 80) are de-
scribed.
2. Extensive animal studies have shown that Tween 80 is innocuous when given
orally in relatively high doses.
3. The oral administration of Tween 80 in doses of 4.5-6 grams per day to more
than one hundred human subjects for periods up to four years has been unattended
by any clinical evidence of ill effect, alteration of metabolic rate and blood chemis-
tries, change in excretion of water soluble vitamins, or evidence of damage to liver,
kidneys, and hematopoetic system.
4. Analysis of the urine and stools of subjects who have ingested Tween 80 showed
complete elimination of the polyoxyethylene moieties of the emulsifier from the
human body. Approximately five per cent of the polyol was excreted in the urine and
95 per cent in the stool.
5. Tween 80 appears to be completely harmless for human ingestion in amounts of
at least 6.0 grams per day as judged from the available data and the four year period
of observation.
REFERENCES
1. Wollaeger, E. E., Comfort, M. W. and Osterberg, A. E.: Total solids, fat and nitrogen in
the feces. TIL A study of normal persons taking a test diet containing a moderate amount of
fat; comparison with results obtained with normal persons taking a test diet containing a
large amount of fat, Gastroenterology 9: 272, 1947.
2. Culver, P. J. and Jones, C. M.: Unpublished data.
3. Jones, C. M., Culver, P. J., Drummey, G. D. and Ryan, A. E. : Modification of fat absorption
in the digestive tract by the use of an emulsifying agent, Ann. Int. Med. 29: 1, 1948.
4. Holt, L. E., Jr.: Unpublished data reported in Ref. 11, p. 34, 1949.
5. Sobel, A. E., Besman, L. and Kramer, B.: Vitamin A absorption in the newborn, A. J. Dis.
Child. 77: 576, 1949.
6. May, C. D. and Lowe, C. U.: The absorption of orally administered emulsified lipid in normal
children and in children with steatorrhea, J. Clin. Invest. 27: 226, 1948.
7. Johnson, A. L., Scott, R. B. and Newman, L. H.: "Tween 20" and fecal fat in premature in-
fants, A. J. Dis. Child. 80: 545, 1950.
8. Becker, G. H., Meyer, J. and Necheles, H.: Fat absorption and atherosclerosis, Science 110:
529, 1949.
9. Becker, G. H., Meyer, J. and Necheles, H.: Fat absorption in young and old age, Gastro-
enterology 14: 80, 1950.
10. Atlas surface active agents, Atlas Powder Company, Wilmington, Delware, 1950.
11. The nature, suitability for and uses in foods and pharmaceuticals of sorbitol, mannitol and
emulsifiers, Atlas Powder Company, Wilmington, Delware, 1949.
56 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
12. Harrisson, J. W. E.: Unpublished data reported in record of bread standards hearing, Federal
Security Agency, Washington, D. C, p. 16798, 1949.
13. Gomori, G.: The microtechnical demonstration of sites of lipase activity, Proc. Soc. Exper.
Biol. & Med. 58: 362, 1945.
14. Archibald, R. M.: Determination of lipase activity, J. Biol. Chem. 165: 443, 1946.
15. Carr, C. J. and Krantz, J. C, Jr.: Effect of feeding calcium arabonate in diet of rats for suc-
cessive generations, Proc. Soc. Exper. Biol. & Med. 59: 54, 1945.
16. Hopper, S. S., Htjlpieu, H. R. and Cole, V. V.: Some toxicological properties of surface-active
agents, J. A. Pharm. Assn., Sci. Ed. 38: 428, 1949.
17. Dubos, R. J.: Unpublished data, reported in record of bread standards hearing, F.S.A., Wash-
ington, D. C, p. 15672, 1949.
18. Kellner, A., Correll, J. W. and Ladd, A. T. : Effect of polyoxyalkylene sorbitan monooleate
on blood cholesterol and atherosclerosis in cholesterol-fed rabbits. Proc. Soc. Exper. Biol. &
Med. 67: 25, 1948.
19. Ladd, A. T., Kellner, A. and Correll, J. W.: Intravenous detergents in experimental athero-
sclerosis, with special reference to the possible role of phospholipids, Federation Proceedings,
8: 360, 1949.
20. Krantz, J. C, Jr., Carr, C. J., Bird, J. G. and Cook, S.: Pharmacodynamic studies of poly-
oxyalkylene derivatives of hexitol anhydride partial fatty acid esters, J. Pharmacol. & Exper.
Therap. 93: 188, 1948.
21. Krantz, J. C, Jr., Carr, C. J., Bubert, H. M. and Bird, J. G.: Drug allergy in the canine
family, J. Pharmacol. & Exper. Therap. 97: 125, 1949.
22. Ivy, A. C, Tanturi, C. A., Hernandez, R. and Baroso, E.: Urticarial reaction induced in the
dog by intravenous injection of sorbitol monolaurate, Arch. Dermatology & Syphilology, 58:
659, 1948.
23. Grossman, M. I. and Robertson, C. R.: Stimulation of gastric secretion by urticariogenic
wetting agent (Tween 20) and its inhibition by benadryl, Proc. Soc. Exper. Biol. & Med. 68:
550, 1949.
24. Culver, P. J., Wilcox, C. S., Jones, C. M. and Rose, R. S.: In press.
A METHOD OF DIVIDING INTRACARDIAC STRUCTURES WITHOUT
OPENING THE HEART CHAMBERS*!
ROBERT S. PENTON, M.D. and OTTO C BRANTIGAN, M.D.
DIVISION OF INTRACARDIAC STRUCTURES
The problem of direct surgical attack upon intra-cardiac structures has vexed
investigators since the idea was first entertained by Sir Lauda Brunton in 1902. *
Techniques for the division of stenosed mitral and aortic valves have varied from the
early blind use of hooks and knives2"5 to the more recent well controlled methods of
division of the mitral valve worked out by Bailey9, Harken10, and Smithy6-8.
It is the purpose of this paper to present an approach for producing experimental
mitral insufficiency. This idea evolved from a desire to produce insufficiency in dogs
with the least possible insult to cardiac physiology resulting from the method itself.
This has been accomplished in each case without changing the normal position of the
heart, with only slight trauma to the heart wall, and with minimal hemorrhage.
Materials consist of a triple zero braided steel suture on a 7 cm. pliant dull atrau-
matic needle.
The left hemithorax is opened between the fourth and fifth ribs. The lung is pro-
tected with moist gauze. A longitudinal incision is made in the pericardium, anterior
and parallel to the phrenic nerve. The position of the heart is maintained by grasping
a pericardial reflexion near the left auricle with a straight clamp. The especially pre-
pared needle is bent to a full curve and is introduced into the cavity of the left auricle
lateral to the base of the appendage. The needle is passed through the center of the
auriculo-ventricular orifice and is directed out through the lateral wall of the left
ventricle 2 cm. inferior to the auriculo-ventricular groove. One now has a suture pass-
ing into the left auricle between the mitral cusps and out through the wall of the
ventricle. The needle is now straightened to a one half curve and is reintroduced into
the left ventricle at its exact point of exit, a maneuver which is greatly facilitated by
the dull point. By placing a finger on the wall of the ventricle superior to the puncture
site, one is then able to direct the dull point of the needle along the inner wall of the
heart through the base of the valve cusp along the wall of the auricle and out the
original point of the entrance. The two ends of the suture are now grasped, and that
distal suture remaining outside is pulled into the left ventricle, thus forming a loop
about the valve cusp. (Figure 1)
One can then divide the cusp by slight traction combined with a to and fro motion
of the suture which, because of its strength and hard scabrous surface, may be used
in somewhat the same manner as one would use a Gigli saw. When the cusp is com-
pletely divided, the suture becomes slack and can be pulled out through the original
point of entrance.
* From the Department of Surgery, School of Medicine, University of Maryland, Baltimore,
Maryland.
t Received for publication April 10, 1951.
57
58
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
The wound, resulting from the repeated penetration of the ventricle, has in no
case required a hemostatic suture. Hemorrhage from the auricle has been easily con-
trolled by a single bite with a straight clamp applied after final withdrawal of the
suture. This not has been necessary in every case.
Topical and intramural procaine was used in one-half of the cases with no apparent
difference in results.
Insufficiency has been indicated at the time of operation by an immediate enlarge-
ment of the left auricle accompanied by increased intra-auricular pressures.
Fig. 1
Post mortem examinations of ten dogs confirmed the division of the mitral valve
in every case. Two months following operation, all cusps were found to be cleanly
divided without evidence of healing. The absence of torn or ragged edges is probably
caused by the suture material being used as a saw, while the pull of the chordae ten-
dinae prevents folding or wrinkling of the cusp.
This method of valvulotomy has proved to have several distinct advantages when
used on the experimental animal. Operating time is shortened. The heart remains
in its normal position. There is practically no hemorrhage, and trauma to the heart
wall is minimal. Although the procedure is completely blind, one has excellent con-
trol of the position of the cutting suture as evidenced by the post mortem examination
of the ten dogs in this series.
PEXTOX AND BRANTIGAN— INTRACARDIAC STRUCTURES 59
Experimentally, the method has also been used to divide the interauricular sep-
tum, the tricuspid, pulmonary, and aortic valves.
In the only patient in which this technique has been used, an eleven month old
infant, no difficulty was encountered in producing an interauricular septal defect
1 cm. in length. Neither was serious hemorrhage encountered. However, the patient
was an extremely poor risk and died immediately following the closure of the chest.
A post mortem examination of the heart revealed dextro-position of the aorta, an
interventricular septal defect, and a patent ductus arteriosis.
REFERENCES
1. Brunton, L.: Preliminary Note on the Possibility of Treating Mitral Stenosis by Surgical
Methods. Lancet, London, 1: 352 (1902).
2. MacCallum, W. C: On the Mechanical Effects of Experimental Mitral Stenosis and Insuffi-
ciency. Bull. J. H. H., 185: 260 (1906).
3. Cushing, H. and Brance, J. R. B.: Experimental and Clinical Notes on Chronic Valvular
Lesions in the Dog and Their Possible Relation to a Future Surgery of the Cardiac Valves.
Med. Res., 17: 471 (1907).
4. Cutler, E. C, Levine, S. A., and Beck, C S-: The Surgical Treatment of Mitral Stenosis:
Experimental and Clinical Studies. Arch. Surg., 9: 689 (1924).
5. Cutler, E. C. and Beck, C. S.: The Present Status of Surgical Procedures in Chronic Val-
vular Disease of the Heart. Arch. Surg., 18: 403 (1929).
6. Smithy, H.: Experimental Aortic Valvulotomy. Surg., Gynec., and Obst, 84: 625 (1947).
7. Smithy, H.: Aortic Valvulotomy. Surg., Gynec, and Obst., 86: 513 (1948).
8. Smithy, H.: Surgical Treatment of Constrictive Valvular Disease. Surg., Gynec, and Obst., 90:
175 (1950).
9. Bailey, C. P., et al.: The Surgery of Mitral Stenosis. J. Thoracic Surgery, 19: 16 (1950).
10. Harken, D.: The Surgical Treatment of Mitral Stenosis. J. Thoracic Surgery, 19: 1 (1950).
FASCIAE AND SUBPERITONEAL FASCIAL SPACES OF THE MALE
PELVIC CAVITY*
EDUARD UHLENHUTH, PH.D.**fH
The peritoneal sac, although it extends from the abdomen into the pelvis, does
not descend all the way to the pelvic diaphragm. Its most caudal level is attained in
the male rectovesical pouch about three inches (and in the female rectovaginal pouch
of Douglas about two inches) cranial to the anterior commissure of the anus. Be-
cause of this arrangement, the entire supradiaphragmatic part of the pelvic cavity
is divided by the peritoneum into a supraperitoneal portion and a subperitoneal
space. The latter is located between the peritoneum and the pelvic diaphragm and
is continuous with the retroperitoneum of the abdomen in which the kidneys and
ureters are contained.
The present article concerns only the subperitoneal space of the pelvic cavity, and
structures which are located below the peritoneum. Although in the male only two
major organs (bladder and rectum) are contained in this space, this part of the pelvic
cavity is beset with difficult problems of spacial orientation as it is subdivided into a
number of secondary "fascial" compartments by partitions which represent parts of
the "visceral endopelvic fascia". Visualization, study, and presentation of the rela-
tionships between the different fascial spaces and of the many different levels and
planes of the individual fascial sheets is one of the major tasks for the anatomist,
teacher and surgeon.
A series of special dissections of the cadaver, suitable to the study and demonstra-
tion of the visceral fasciae and fascial spaces of the pelvis have been prepared. Struc-
tures occupying a relatively small space in many different planes, present a difficult
problem to the artist who attempts to illustrate them. Two-dimensional illustrations
give only a partial visualization of complicated three-dimensional bodies; neverthe-
less, an attempt will be made to discuss this subject with the aid of some specially
selected pictures.1 This is done to establish the importance of visceral endopelvic
fasciae in the dissecting room and in surgery.
Parietal Endopelvic Fascia
The parietal endopelvic fascia is briefly mentioned here because through it, the
visceral fasciae gain attachment to the walls of the pelvic cavity, and because of its
important relationship to vessels and nerves.
The parietal endopelvic fascia is the fascia which lines the pelvic cavity in one
continuous sheet and covers the muscles of the pelvic wall and floor. This fascia pre-
sents a peculiar relationship to vessels and nerves, which is useful to remember. Al-
* Adapted for publication from a lecture introductory to a demonstration course given as part
of a "Postgraduate Urological Seminar," at the Baltimore meeting of the "Mid-Atlantic Section
of the American Urological Association," January 30 and 31, 1950.
** Aided by a grant from the John F. B. Weaver Fund of the School of Medicine, University of
Maryland, and a personal contribution from Dr. Albert E. Goldstein.
f From the Department of Anatomy, University of Maryland School of Medicine.
H Received for publication July 1, 1950.
60
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 61
though there exist several accounts in which such a relationship is denied or mini-
mized (3), it can nevertheless be demonstrated by dissection that the parietal fascial
forms a partition between the neural and vascular levels. With the exception of a
single nerve in the cavity of the lesser pelvis (obturator nerve), not one of the somatic
nerves can be seen within the space lined by the parietal fascia. All the somatic
nerve-trunks and the lumbosacral, pudendal and coccygeal nerve plexuses are
located "subfascial"; that is to say, between the parietal fascia and the muscles
covered by it. In order to display them, the parietal fascia must be incised and
stripped away from the muscles.
Quite the contrary is true for the vessels and for the autonomic nerve plexus. The
vessels are located inside the space lined by the parietal fascia and are embedded in
the visceral fascia. The parasympathetic nerves originate from the sacral trunks in
the subfascial space but pierce immediately the parietal fascia, enter the pelvic
cavity, and travel in special visceral fascial sheaths to the viscera which they supply.
To find them, the parietal fascia need not be disturbed ; rather it is necessary to know
the visceral sheaths in which they travel.
Neurovascular Sheaths, A Reality
While the configuration of the parietal endopelvic fascia is relatively simple, the
visceral endopelvic fascia is difficult to demonstrate and to describe. Anatomists
attempted to escape presentation and analysis of this part of pelvic anatomy by re-
ducing the entire visceral endopelvic fascia to the fascial capsules, ensheathing such
organs as the bladder, prostate gland, vagina, and rectum. This also includes simple,
diffusely distributed, undifferentiated, loose packing tissue (8). General agreement
exists concerning the fascial capsules: also the presence of loose packing tissue is
generally granted. The most controversial subject, however, is the neurovascular
sheaths, the presence of which is not generally recognized. They do exist and can
be distinctly demonstrated if proper dissection is made. These sheaths serve as
conduits for vessels and nerves which they carry from the periphery of the pelvic
cavity to the organs, and are an important component of the fixation apparatus by
which the pelvic viscera are anchored to the pelvic walls and floor. Each of these
sheaths is composed of two fascial membranes between which loose packing tissue,
fat, nerves, blood, and lymph vessels are embedded.
From the surgical viewpoint the great importance of the neurovascular sheaths
has been particularly emphasized by gynecologists. Foremost among them were
Wertheim and Schauta. Their pupils, Peham and Amreich, in their classical work
on "Operative Gynecology", gave the first exhaustive description of these structures.
Line of Anchorage
The neurovascular sheaths or the hypogastric wings are "anchored" peripherally
to the parietal fascia and are attached centrally to the fascial capsules of the viscera,
with which they are continuous.
The "line of anchorage" has been well illustrated by Eduard Pernkopf in his
monumental work "Topographische Anatomie". It starts (Fig. 1) cranially at the
point where the hypogastric artery originates from the common iliac artery and passes
62
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
downward and backward (roughly in a vertical direction), along the hypogastric
artery and its anterior division, to the ischial spine, approximately parallel to the
dorsal margin of the superior ischial ramus and in front of the greater sciatic fora-
L
Fig. 1
The anchorage line of the visceral endopelvic fascia as illustrated by Pernkopf under the name
of "neurovascular plate" (Gefaess-Nerven-Leitplatte). Both the vertical (1) and the horizontal
portion (2) as well as the angle which they form against one another are shown. Cranial to the hori-
zontal part of the anchorage line, the tendinous arch of Levator ani (3) is seen. The parietal fascia
has been left in place; through it the muscles and the trunks of the sacral plexus are showing. Note
the two fascial leaves bordering the vertical portion of the anchorage line.
Taken from Pernkopf's Topographische Anatomie, 1943, vol. II, Fig. 71 (redrawn and somewhat
modified) .
men. At the level of the ischial spine, it makes a sharp turn forward of nearly
90 degrees, passing forward and downward (roughly in a horizontal plane) across
the levator ani, ending close to the lower end of the symphysis pubis.
The vertical portion of the line of anchorage is the "hypogastric root", the hori-
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 63
zontal portion being represented by the well known "fascia endopelvina", a some-
what confusing term the use of which has continued only because of its antiquity.
The hypogastric root is a thick strip of visceral fascia which is bordered on either
side, laterally and medially, by distinctly membranous layers of fascia arising from
the parietal fascia (Fig. 1). Between these two layers are contained the ventral divi-
sions of the hypogastric vessels, the origins of the visceral branches of these vessels,
and the ureter.
The fascia endopelvina is a horizontal fascial shelf which forms the floor of the
space of Retzius and is encountered if the hand is pushed down into this space. It
will be discussed later in the section describing the space of Retzius. It arises from
the parietal fascia along the so-called "white line" of the fascia endopelvina. This
structure commences dorsally at the spine of the ischium, crosses the levator ani,
and runs forward to the lower end of the symphysis pubis, where it meets with its
fellow of the opposite side. If the space of Retzius is exposed to view by pulling the
bladder away from the symphysis pubis and lateral pelvic wall (Fig. 2), the fascia
endopelvina is seen as it occupies the floor level of the space of Retzius.
General Appearance of Neurovascular Sheaths
If the peritoneum is carefully raised, it is found that underneath it a continuous
and well denned fascial membrane is present, expanded between the peritoneum
and the parietal fascia. Figure 3 shows a preparation in which the entire peritoneum
has been stripped away, leaving only the peritoneum of the bottom of the rectovesi-
cal pouch. In such a preparation, the visceral fascia is seen to reproduce faithfully the
general configuration of the peritoneum. If the fascia is now cautiously lifted off the
pelvic walls, its sheet-like nature can be demonstrated. Such a dissection is illustrated
in Figure 4. After the fascial sheet had been separated from the parietal fascia, it
was elevated by hooks and held stretched out in a wire frame to demonstrate the na-
ture of this fascia as a well differentiated individual structure. Any one of these fascial
sheets may be grasped and pulled with force to demonstrate the great resistance of
the visceral sheets to tension.
As is shown in Figure 4, the visceral endopelvic fascia is continuous everywhere,
with a similar fascia in the abdomen (visceral endogastric fascia). Ventrally, it is
continued into the vesicoumbilical fascia; laterally, into the visceral endogastric
fascia of the iliac fossa; and dorsally, it becomes continuous with a fascia which en-
closes, among many other structures, the ureter and the large vascular trunks of the
abdomen and, further cranially, represents the perirenal fascia.
In Figure 3, the major neurovascular sheaths, of which the visceral endopelvic
fascia is composed, are visible partly or in their entirety. The location of the hypo-
gastric root (vertical anchorage line) is indicated by the cranial (vertical) portion of
the ureter. Arising from it are two extensive fascial sheaths, dorsal and ventral. The
dorsal or presacral hypogastric wing sweeps across the sacrum and becomes continu-
ous with its fellow of the opposite side. The ventral wing sweeps forward along the
lateral wall of the pelvis and is divided by the horizontal (ventrocaudal) portion of
the ureter and by the bladder into a superior and inferior hypogastric wing. The
presacral wing is that part of the fascia which is continued into the fascia around the
64
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
aorta, inferior vena cava, and perirenal fascia. The superior hypogastric wing is
continued laterally into the visceral fascia of the iliac fossa, extends downward and
forward from the external iliac vessels to the bladder and is continuous with the
capsule on the superior surface of the bladder. It contains the horizontal portion of
the vas deferens and also the umbilical arteries, following them upon the ventral wall
Fig. 2
Floor of the space of Retzius
Peritoneum stripped away and removed. Right superior hypogastric wing and vesico-umbilical
fascia cut away from their peripheral attachments and pulled laterally and dorsally together with
the bladder, to obtain a view into the ventral and right lateral compartments of the space of Retzius.
1) Superior hypogastric wing with umbilical artery. 2) Vesico-umbilical fascia. 3) Bladder (in-
ferolateral surface). 4) Deep dorsal vein of penis. 5) Medial pubovesical ligament. 6) Lateral pubo-
vesical ligament. 7) Lateral true ligament of bladder (ventral portion of fascia endopelvina). 8)
Dorsal crescentic margin of lateral true ligament of bladder. 9, 10 and 11) White lines of origin of
fascia endopelvina. 12) Cranial commencement of hypogastric root, with ureter in it. 13) Presacral
hypogastric wing. 14) Fascial core of mesosigmoid.
Pelvis (479. „ . , 1948, fig. 7) of white male, 70 vears of age.
42 b
of the abdomen where it forms, between the left and right obliterated umbilical arter-
ies, the vesicoumbilical fascia. The inferior hypogastric wing which is only partially
visible, lies caudal to the horizontal part of the ureter. It runs forward and downard
toward the posterior surface of the bladder and prostate gland and is attached to the
capsules of these organs.
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY
65
Both the dorsal and the ventral wing are attached in their entirety to the anchorage
line. In Figures 3 and 4, only the vertical portion (hypogastric root) of this line is
visible.
V l-3
Fig. 3
Visceral endopelvic fascia, after removal of peritoneum
Peritoneum pealed away from visceral endopelvic fascia and cut away except at the bottom of
rectovesical pouch.
1) Rectovesical pouch. 2) Cranial continuation of rectovesical septum. 3) Transversalis (parietal)
fascia. 4) Psoic (parietal) fascia. 5) Iliac (parietal) fascia. 6) Hypogastric root, with ureter in it.
7) Presacral wing, with fascial core of mesosigmoid. 8) Superior hypogastric wing, with horizontal
portion of vas deferens (9) and obliterated umbilical artery (10) in it. 11) Vesico-umbilical fascia.
12) Visceral endogastric fascia on ventral abdominal wall. 13) Visceral endogastric fascia in iliac
fossa.
Pelvis (479 , fig. 3) of male negro, 68 years of age.
Superior Hypogastric Wing
As mentioned above, the ventral wing is divided into a superior and an inferior
portion. Dorsally, this division is effected by the ureter, without breaking the con-
tinuity between the two portions. Ventrally, the continuity between the superior
and inferior hypogastric wings is actually interrupted as the bladder is interposed
between them.
In Figures 3 and 4, the superior hypogastric wing is seen from its medial aspect.
In Figure 5, the superior hypogastric wing was cut away from its attachment to the
66
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID.
external iliac vessels and, together with the bladder, was turned medially. It is now
visible from its lateral aspect which faces the space of Retzius. By pulling the bladder
medially, the space of Retzius has been opened in its entire extent. Dorsally, the
hypogastric root is visible. The superior hypogastric wing is seen as it arises from the
«"-*
L
Fig. 4
Neurovascular wings of visceral endopelvic fascia
Peritoneum pealed off and cut away except for the peritoneum of the bottom of rectovesical
pouch. Visceral endopelvic fascia and its continuations into the visceral endogastric fascia lifted
off the parietal fascia and held spread out and suspended by hooks.
1) Rectovesical pouch. 2) Hypogastric root with ureter. 3) Presacral wing with fascial core of
mesosigmoid and 4) its continuation into the fascia of abdominal retroperitoneum. 5) Superior
hypogastric wing with 6) Horizontal portion of vas deferens. 7) Lateral continuation of superior
wing into iliac fossa. 8) Ventral continuation of superior wing upon ventral abdominal wall and
9) into vesico-umbilical fascia. 10) Rubber tube in retrorectal space. 11) Rubber tube in lateral
compartment of space of Retzius.
Pelvis (479 , 1949, fig. 2) of a white male, aged 72 years. Dissection made by DeWitt T. Hunter.
hypogastric root, passes forward and, reaching the lateral angle of the bladder, at-
taches itself to the lateral margin of the superior bladder surface. The umbilical artery
runs in it, close to the margin along which the wing was cut away from its lateral
attachment. The umbilical artery gives rise to the superior vesical arteries (not shown
in Figure 5). There may be as many as five such branches, all of which are enclosed
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY
67
between the two fascial layers of this wing and are carried by it to the superior, and
part of the posterior, surface of the bladder.
In the male, the vas deferens runs on the superior surface of this wing, pursuing a
horizontal course toward the spine of the ischium, where it pierces the fascia, takes a
r
%zrfT,
Fig. 5
Neurovascular wings of visceral endopelvic fascia
Peritoneum pealed away and removed. Superior hypogastric wing cut away from its lateral
attachment and, together with the bladder, pulled medially. View into space of Retzius.
1) Superior hypogastric wing, seen from its lateral aspect. 2) Bladder (inferolateral surface).
3) Hypogastric root. 4) Inferior hypogastric wing, with inferior vesical vessels in it. 5) Presacral
hypogastric wing. 6) Medial pubovesical and 7) Lateral pubovesical ligament, both freed of their
fascial covering. 8) Lateral true ligament of bladder, with covering of thin fascia endopelvina left
in place. 9) Peritoneum in iliac fossa. 10) Visceral endogastric fascia in iliac fossa, continued from
superior wing.
Right half of pelvis (479 , 1946, fig. 5) of colored female, 29 years of age.
sharp turn caudally, and enters the retrovesical space as shown in Figure 8. The
superior wing excludes the vas deferens from the space of Retzius which lies caudal
to this wing (see below). It should be kept in mind that the vas deferens is nowhere
in actual contact with the floor of the pelvis. In its horizontal course, while running
68 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
dorsally upon the superior wing, the vas crosses medial and cranial to the obliterated
umbilical artery.
Inferior Hypogastric Wing
In Figure 5 the inferior hypogastric wing is shown in its entirety from its lateral
aspect, facing the space of Retzius. Its relation to the superior wing and to the
bladder is as follows: From its origin (hypogastric root), it passes forward in con-
tinuity with the superior wing, delineated from it only by the ureter. As the lateral
angle of the bladder is reached, the two wings become actually separated. The superior
wing follows the lateral margin of the superior bladder surface, while the inferior wing
becomes attached to the lateral margin of the posterior bladder surface. In Figure 5
the origin of the inferior wing from the hypogastric root as well as from the fascia
endopelvina (horizontal part of anchorage line) is visible. The inferior vesical veins
and arteries are contained in this wing and are carried in it down to the dorsal and
inferior bladder surfaces to the seminal vesicles, ampullae of vasa deferentia and
prostate gland. Some of them are illustrated in Figure 5.
The inferior wing has a special relation to the hypogastric root shown in Figure
6 which is another stage of the dissection of the female pelvis illustrated in Figure 5.
The pelvis here was tilted so as to expose a view of the entire anchorage line. Its
vertical portion, the hypogastric root, ends caudally in a toughened arch, the inferior
vesical arch, which can be distinctly felt with a finger pushed dorsally in the
space of Retzius. Laterally, this arch is attached to the ischial spine; medially, it is
continued into the inferior wing. In it are situated large inferior vesical veins and
one or several inferior vesical arteries. In the dissection shown in Figure 6, a win-
dow was cut out of the fascia covering the ventral surface of the inferior vesical
arch; through it the inferior vesical vein is seen passing to the hypogastric veins.
Just below the inferior vesical arch, one finds frequently a second arch (Fig. 6)
which marks the dorsal end of the fascia endopelvina. The convexities of the two
arches facing each other and the space between them is filled in by fat and a fascial
membrane of varying strength. This second arch marks the location of the tough,
strongly aponeurotic, superior margin of the coccygeus muscle. In many cases the
terminal branches of the anterior division of the hypogastric vessels, the inferior
gluteal and internal pudendal, pass into the infrapiriform space of the greater sciatic
foramen just behind this second arch, while the inferior vesical vessels are joined to
the anterior division of the hypogastric artery a short distance cranial to this arch.
This kind of arrangement, together with the attachment of the inferior vesical arch
to the ischial spine, furnishes a particularly strong and effective mooring of the
inferior hypogastric wing to the wall of the pelvis, very resistant to tension exerted
in a ventral direction.
The inferior hypogastric wing is of considerably greater bulk than the other wings.
This is shown in a special dissection (Fig. 7), illustrating the inferior wing and the
bladder from a medial and dorsal aspect. After stripping away the peritoneum, the
superior wing was cut away from the inferior wing and from the bladder. The
medial fascial layer of the inferior wing; as well as the capsule on the dorsal
bladder surface, (the two being continuous with one another) were dissected away
VHLENHUTH— FASCIAE OF MALE PELVIC CAVITY
69
Fig. 6
Hypogastric root, inferior vesical arch and fascia endopelvina
Same dissection as Fig. 5, but promontory of pelvis tilted forward to afford full view into lateral
compartment of space of Retzius. Fascia endopelvina more fully dissected.
1) Hypogastric root. 2) Inferior vesical arch with window through which an inferior vesical
vein is shown. 3) Medial pubovesical ligament. 4) Lateral pubovesical ligament. 5) Lateral true liga-
ment of bladder; fascia endopelvina which covers it, incised and retracted, aponeurotic fibers of
ligament displayed and incised, levator ani showing through incision. 6) Thin dorsal portion of
fascia endopelvina, incised, portio cardinalis of levator ani and, further dorsally, coccygeus muscle
showing through incision. 7) Arch at dorsal end of fascia endopelvina. 8) Rubber tube stuck through
fascia which closes opening between inferior vesical arch and dorsal arch of fascia endopelvina.
9) Rubber tube stuck through incision in thin (avascular) part of fascia endopelvina.
Right half of same pelvis as shown in Fig. 5 (479 .„ , 1946, fig. 7).
and reflected. The core of the inferior wing is fully exposed. In the subject illustrated
by Figure 7 it is fully one-half inch thick and gains in height as it passes from its
dorsal origin to the bladder. It is one and one-half inches high where it is attached
70
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
into the bladder. The core of the wing consists of loose packing tissue and consider-
able amounts of fat. Embedded in it (not shown in the illustration) are the ureter,
the autonomous nerves to the urogenital organs, and the arteries and veins supplying
L
Fig. 7
Inferior hypogastric wing
Peritoneum (except bottom of rectovesical pouch) removed, superior hypogastric wing cut away
from inferior hypogastric wing and bladder, fascial leaves bordering inferior hypogastric wing, and
their continuations upon the bladder dissected off to show core of inferior hypogastric wing.
1) Core of inferior hypogastric wing, viewed from medial and dorsal. 2) Dorsal bladder surface.
3) Medial fascial leaf of inferior hypogastric wing, and dorsal bladder capsule. 4) Lateral fascial
leaf of inferior hypogastric wing, and superior bladder capsule. 5) Superior hypogastric wing cut
away from inferior wing and from bladder. 6) Ureter (vertical portion) shelled out from hypo-
gastric root. 7) Visceral nerves to urogenital organs, entering inferior wing from presacral wing.
8) Peritoneum of rectovesical pouch. 9) Rectovesical septum. 10) Genital fascia with ampulla of
vas deferens. 11) Middle lobe of prostate. 12) Dorsal lobe of prostate covered by fascial capsule.
Right half of pelvis (479 , 1950, fig. 3) of white male, 54 years of age.
and draining these organs. Ventrally, the inferior wing, is firmly attached to the
lateral margin of the dorsal bladder surface and is continued there into the capsule
on the dorsal (see Fig. 7) and inferolateral (see Fig. 5) surfaces of the bladder. Dor-
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 71
sally, where the inferior wing arises from the hypogastric root, the ureter makes a
sharp turn forward and enters the inferior wing, representing the most cranial struc-
ture in its content and being carried in it to the lateral bladder angle. Also, two
strong autonomous nerve trunks are seen in Figure 7, as they enter the inferior
wing.
In a preparation such as is illustrated in Figure 7, the inferior wing may be grasped,
and tension in a ventral direction may be exerted upon it. This procedure demon-
strates very convincingly that even vigorous pulling is unable to disengage the
inferior wing from its mooring to the hypogastric root and inferior vesical arch.
Through the intermediation of the inferior wing, the bladder is firmly moored to
the hypogastric wing and inferior vesical arch.
The Presacral Wing
Both the inferior and superior parts of the ventral wing are related to the bladder.
The dorsal or presacral wing is related to the pelvic colon and to the rectum. Like
the ventral wing, it takes its origin along the entire line of anchorage; that is, in its
cranial extent from the hypogastric root, and in its caudal extent from the fascia
endopelvina. In its course from cranial to caudal, it mades the same angle at the
level of the ischial spine. This is described by the line of anchorage and therefore
follows the direction of the rectum which in the lower part of its sacral curvature
also undergoes a change from a vertical to a horizontal direction, passing from the
coccyx forward to the prostate gland.
The cranial portion of the presacral wing, as shown in Figures 3, 4 and 5, is wide
and sweeps across the sacrum where it meets with its fellow of the opposite side.
It is applied by its dorsal surface to the parietal fascia over the piriformis muscle
and sacrum. In its caudal portion it narrows down and is applied to the parietal
fascia over the coccygeus and levator ani muscles.
Cranially, the presacral wing passes behind the pelvic colon, but is attached to
the dorsal aspect of this part of the gut by way of the mesentery of the pelvic colon,
the core of which is formed by a ventral expansion of the presacral wings (Figs.
2, 3 4). Further caudally, where a mesentery is absent, each of the two presacral
wings is attached into the corresponding lateral aspect of the rectum and is continu-
ous with the fascial capsule of the rectum. Thus, it represents a lateral fascial wing
of the rectum by way of which the rectum is fastened on either side to the medial
margin of the fascia endopelvina and through it, to the parietal fascia of the levator
ani.
In its cranial part, the presacral wing contains, between its two fascial layers,
some of the most caudal sigmoid branches of the inferior mesenteric artery, the
superior hemorrhoidal artery, the inferior hypogastric nerve which descends down
into the pelvis medial to the ureter, and the cranial half of the pelvic ganglion (see
Retrorectal Space). In the caudal (horizontal) portion of the presacral wing, the
caudal half of the pelvic ganglion is embedded.
Subperitoneal Fascial Spaces
The hypogastric wings, aided by an additional membranous structure, the recto-
vesical septum (to be described presently), divide the entire subperitoneal space of
72 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
the male pelvis into four fascial spaces. These are (from ventral to dorsal): the
space of Retzius, the retrovesical space, the prerectal space, and the retrorectal
space. The fascial partitions between these spaces and the spaces themselves are
arranged in such a fashion that all of them commence, dorsolaterally, at a common
center represented by the hypogastric root and the spine of the ischium with the
inferior vesical arch attached to it; from this center they radiate, fan-like, towards
the midsagittal plane of the pelvic cavity. This arrangement enables the arteries
and nerves, arising in or carried into the hypogastric root from elsewhere, to enter
any one of the fascial partitions and to reach the organs which they supply. In the
same manner, the veins and lymphatics draining the viscera are carried to the com-
mon center in the hypogastric root and from there up into the abdomen.
Retrovesical Space
As the seminal vesicles and the ampullae of the vasa deferentia are situated in this
space, and because through it, access to the dorsal surface of the prostate gland can
be gained, it is a region of major importance for the urologist. It represents the
ventral compartment of the space between the bladder and the rectum (rectovesical
space) and is partitioned off against the dorsal compartment (prerecetal space)
of this larger space by a well defined membrane, the so-called rectovesical septum.
1. Rectovesical Septum: The rectovesical septum is a membrane which is attached
firmly by its cranial margin to the peritoneum of the rectovesical pouch (Fig. 8).
Laterally, it extends further cranially, sometimes as high as the cranial end of the
hypogastric root, forming on either side of the pelvic cavity a lateral wing of the
peritoneal sac (Fig. 3). In some subjects the rectovesical spetum extends caudally
all the way down to the pelvic floor (Fig. 9). Laterally, it is attached to the common
anchorage line (to the hypogastric root and medial margin of the fascia endopelvina) ;
cranially, however, its line of lateral attachment is variable inasmuch as it may be
attached medial to the hypogastric root and then gain insertion into the lateral
portion of the presacral wing. In either case, this septum extends transversely through
the entire width of the pelvic cavity. It thus forms, either by itself or together with
a most lateral strip of the presacral wing, a partition of the subperitoneal space of
the pelvic cavity into a dorsal or rectal and a ventral or urogenital compartment.
In cases in which the rectovesical septum is well developed, it may well represent at
least for a time an efficient barrier to the passage of abscesses and exudations from
one compartment into the other.
The rectovesical septum is the result of a fusion between the ventral and dorsal
walls of the peritoneal rectovesical pouch, which in early embryonic life extends
between bladder and rectum all the way down to the pelvic floor (Uhlenhuth, Wolfe,
Smith and Middleton (7)). Therefore, this septum consists, potentially, of two layers,
an anterior and a posterior layer. With proper care it actually may be split into these
two layers. In adult subjects in whom this septum is well developed, it can be im-
mediately distinguished from ordinary fascia by a conspicuous difference in texture
and consistency. It is a dense, smooth sheet, often of shiny appearance.
Denonvilliers was the first one to describe the rectovesical septum, (1836), naming
it "Aponevrose prostato-peritoneal". Yet it has not been determined with any
UHLEXHUTH— FASCIAE OF MALE PELVIC CAVITY
73
degree of certainty that what present-day urologists call the "posterior layer of
Denonvilliers' fascia" is the rectovesical septum. In his "Practice of Urology"
(vol. II, p. 420), Young states that .the posterior layer of Denonvilliers' fascia is
identical with the rectovesical septum, while the anterior layer of this fascia is
represented by the capsule on the dorsal surface of the prostate gland. But the ana-
Fig. 8
Retrovesical space
Peritoneum removed, except for bottom of rectovesical pouch.
1) Peritoneum of rectovesical pouch. 2) Rectovesical septum. 3) Supragenital septum. 4) Cap-
sule on dorsal bladder surface. 5) Capsule on ventral surface of rectum. 6) Superior hypogastric wing.
7) Vas deferens (horizontal part). 8) Vas deferens (ampulla), vertical part, in retrovesical space.
9) Presacral wing. 10) Ureter and 11) Hypogastric artery, both abnormally far ventral (caudal pole
of kidney in iliac fossa).
Right half of pelvis (479 ., 1947, fig. 2) of white male, 77 years of age. Dissection made by
43 l
Dr. Karl F. Mech.
tomic description of the posterior layer which he gives in his account of the tech-
nique of perineal prostatectomy, contains so many inconsistencies and is so vague,
that one cannot be certain that the structure which he describes is actually the
rectovesical septum. In an article published in 1908, G. Elliot Smith gave a dia-
grammatic illustration (Fig. 10 on p. 212). From this it appears that when he de-
74
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
scribed a posterior and anterior layer of Denonvilliers' fascia, he had in mind the
two primary leaves of which compose the rectovesical septum. Since both of these
primary layers are attached cranially to the peritoneum of the rectovesical pouch,
the retroprostatic space (of Proust) in this illustration extends all the way up to
Fig. 9
Rectovesical septum and genital fascia
Peritoneum pealed away from visceral fascia and cut away except for peritoneum of rectovesical
pouch. The retrovesical space (between bladder and rectovesical septum) opened up.
1) Rectovesical pouch. 2) Rectovesical septum. 3) Line along which rectovesical septum is grown
to cranial margin of dorsal lobe of prostate gland. 4) Cranial expansion of rectovesical septum.
5) Fascial capsule of dorsal lobe of prostate. 6) Genital fascia, with ampulla of vas deferens enclosed
between its two layers. 7) Sacrogenital ligament (exceptionally well developed). 8) Superior wing
with horizontal part of vas deferens (9) and obliterated umbilical artery (10). 11) Ureter (vertical
part) in hypogastric root. 12) Middle and 13) Dorsal lobe of prostate gland.
Left half of pelvis (47951, 1950, fig. 5) of white male, 54 years old.
the bottom of the rectovesical pouch and lies within the rectovesical septum and
the capsule of the prostate gland.
Added to these difficulties, the anatomist encounters, in an attempt to interpret
the language of the urologist in anatomic terms, the disregard of variations of the
rectovesical septum which in some cases results in complete absence of a posterior
layer of Denonvilliers' fascia dorsal to the prostate gland. It is true, as mentioned
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 75
above, that in some subjects the rectovesical septum is a strong and well-defined
membrane. However, in other individuals, this structure is greatly deficient and
consists only of isolated narrow strips of varying length extending, at the most,
to the base of the prostate gland. In some subjects, the rectovesical septum stretches
all the way down to the pelvic floor (as was the case in the subject illustrated in
Fig. 9). In many cases, the rectovesical septum is attached to the margin of the
base of the prostate or along some line farther caudal on the dorsal surface of the
prostate. It cannot be dissected any further down because it fades out into the
prostatic capsule. In all these instances, the prostate gland is separated from the
ventral capsule of the rectum only by loose areolar tissue, filling in a rectoprostatic
space. However, a retroprostatic space, in the sense of a space between the recto-
vesical septum and the prostate, is not developed.
Even in those cases in which the rectovesical septum extends down to the pelvic
floor, it presents constantly a firm attachment to the cranial margin of the posterior
lobe of the prostate gland (as mentioned also by Lowsley and Kirwin, vol. I, p. 796),
whereas everywhere else in the dissection of the rectovesical septum, separation can
be made easily with a blunt instrument. The sharp edge of the knife is necessary to
detach the rectovesical septum in this place. Frequently, as the rectovesical septum
is cut away from this attachment, the outer capsule of the prostate gland comes
along with the septum (Fig. 9). This capsule, as seen in embalmed dissecting-room
specimens, is about of the same thickness as the rectovesical septum and of apo-
neurotic appearance. After peeling this capsule away from the prostate gland, a
thicker marginal zone, lighter in color than the rest of the prostatic tissue, remains.
This marginal tissue can be peeled away with the aid of the semiblunt edge of a
spatula-probe. It is brittle and does not have the consistency or appearance of a
true fascial capsule. The middle lobe has its own individual capsule which seems to
be a continuation of the capsule on the dorsal bladder wall (Fig. 7).
When, in the sagittally divided pelvis of embalmed cadavers, an attempt is made
to pull the rectum away from the bladder and prostate gland, the rectovesical septum
goes invariably with the latter two organs and not with the rectum. It is only
loosely attached to the rectum by a quantity of delicate areolar tissue which is
easily broken down either with the finger or, in some subjects, by mere tension.
2. Supragenital Septum: Gynecologists are well acquainted with the presence of
a fascial septum, the supravaginal septum, which forms the roof of the vesicovaginal
space, and which separates this space from the vesicocervical space. This must be
cut through if access is to be gained from one into the other of these two spaces. A
similar, though less substantial, septum forms the roof of the retrovesical space in
the male (Fig. 8).2 This "supragenital septum" must be cut through if access to
the seminal vesicles, ampullae, and prostate gland from the intrapelvic side is sought.
As is shown in Figure 8, the supragenital septum is attached dorsally to the perito-
neum of the rectovesical pouch, ventrally to the bladder capsule along the dorsal
margin of the superior bladder surface, and laterally to the ventral hypogastric wing
along a line corresponding to the boundary between superior and inferior hypogastric
wings. The vas deferens, which in its horizontal course runs towards the ischial spine
in a special sheath on the upper surface of the superior wing, pierces this fascia just
76
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
where it is joined to the supragenital septum and thus enters the retrovesical space
(Fig. 8). Because of the presence of the supragenital septum, stripping away the
peritoneum alone does not open up the retrovesical space (Fig. 10). To bring this
Fig. 10
Retrovesical space closed by supragenital septum
Peritoneum pealed off and cut away except for the bottom of rectovesical pouch. Visceral endo-
pelvic fascia left intact, retrovesical space closed by supragenital septum.
1) Peritoneum of rectovesical pouch. 2) Cranial expansion of rectovesical septum. 3) Ureter in
hypogastric root. 4) Presacral hypogastric wing. 5) Fascial core of mesosigmoid. 6) Superior hypo-
gastric wing. 7) Bladder (superior surface). 8) Supragenital septum, closing retrovesical space.
Pelvis (479 0 , , 1948, fig. 1) of white male, 70 years of age. Dissected by Dr. Edmund B. Mid-
dleton.
space into view, its fascial roof must be incised close to the dorsal margin of the
superior bladder surface (Fig. 11). Digging downward and forward into this space
with a finger, brings into view the vertical course of the vas deferens and the seminal
vesicles as shown in Figure 11. Dorsal to the finger and in front of the rectum, a
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY
77
strong membrane, the rectovesical septum, is visible. This can be picked up with a
pair of forceps and lifted off the rectum.
In the specimen illustrated in Figure 11, a knob-like projection with glistening
whitish surface was seen protruding upward between the two ampullae. It was be-
Fig. 11
Retrovesical space opened up
Same dissection as Fig. 10, but supragenital septum cut through transversely and retrovesical
space opened. Ureter dissected out from inferior hypogastric wing as far ventrally as to the place
where it is crossed by vas deferens.
1) Supragenital septum incised transversely. 2) Retrovesical septum. 3) Vas deferens, hori-
zontal portion, in superior hypogastric wing. 4) Vas deferens, vertical portion with ampulla, in retro-
vesical space. 5) Seminal vesicle. 6) Bladder. 7) Prostate gland (presumably enlarged middle lobe).
8) Ureter in hypogastric root. 9) Ureter in inferior hypogastric wing, crossed by vas deferens.
Same pelvis as Fig. 10 (479 , 1948 fig. 2). Dissection made by Dr. Edmund B. Middleton.
lieved to be en enlargement of the median lobe of the prostate, but was not further
examined. Although the prostate gland can be felt, if the finger is thrust down far
enough, the finger is unable to enter the retroprostatic space of Proust because of
the firm attachment of the rectovesical septum to the cranial margin of the prostate
gland (see Fig. 9). This attachment must be cut through before the dorsal surface of
the prostate gland can be reached.
78 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
In an attempt to enlarge the retrovesical space laterally, the fingers are stopped
by a firm wall, the inferior hypogastric wing, which forms the lateral wall of this
space. Following this wall, one can dig on either side of the rectum nearly as far
back as the ischial spine and the hypogastric root. It is to be remembered that in the
upper border of the inferior hypogastric wing, hidden under the fascial leaf which
covers the medial surface of it, the ureter passes forward to the bladder and is
crossed on its ventrocranial aspect by the vas deferens close to the point where the
vas enters the retrovesical space and turns downward and forward (Fig. 11). More-
over, coming out of the inferior hypogastric wing, piercing the fascial leaf which
covers it, a number of nerves and arteries are seen, which supply the ampulla, seminal
vesicles, prostate and dorsal bladder surface. These structures are seen to better
advantage in Figure 12; the medial fascial leaf of the inferior wing has been lifted
off the core of the wing, and the cranial end of the pelvic ganglion located. Large
masses of nerves arise from it, some of them passing together with the ureter within
the inferior wing forward to the bladder, while others pierce the medial fascial leaf
and enter ampulla of vas and seminal vesicle. In Figure 12 also, the fascia covering
the presacral wing was slit open just medial to the hypogastric root and ureter;
the inferior hypogastric nerve is exposed and is seen to join the cranial end of the
pelvic ganglion.
3. The Genital Fascia : When the rectovesical septum is peeled away from the dor-
sal bladder surface, the ampullae of the vasa deferentia and the seminal vesicles
frequently remain attached to the ventral surface of the septum. Wtih proper care
it can be shown that they are not directly attached to the rectovesical septum, but
are enclosed in a separate fascia, the genital fascia, which is closely apposed to the
septum and held loosely to it by a small amount of delicate loose connective tissue.
It is actually fused only by its cranial margin either with the ventral surface of the
septum or even with the supragenital septum (see Figs. 7 and 13). Around the seminal
vesicles and the ampullae, the genital fascia is split into two layers, ventral and dorsal.
These form a fascial sheath around these organs (Fig. 13). Caudally, the ventral
layer is attached to the cranial margin of the middle lobe. The dorsal layer is attached
to the cranial margin of the posterior lobe (Fig. 9). To free the vasa and seminal
vesicles of this fascia consumes, at least in the cadaver, much time. But if the genital
fascia is cut through along its cranial and caudal lines of attachment and the ejacula-
tory duct is severed, these organs can be easily lifted out together with the genital
fascia.
Judging from the condition in the adult, one concludes that the genital fascia is
homologous to the ligament of Mackenrodt in the female. In this connection, it is of
interest that in the same way in which in the female the uterine nerves and vessels
leave ureter and inferior vesical vessels (which pass within the inferior wing forward
to the bladder) and turn medially towards the uterus, so the vessels and nerves for
the seminal vesicles and ampullae in the male leave the inferior wing, turn medially
and enter the genital fascia in the retrovesical space to supply these organs.
4. Borders of Retrovesical Space: The retrovesical space is bordered vent rally by
the dorsal surface of the bladder, dorsally by the rectovesical spetum, laterally
(and ventrally) by the inferior hypogastric wings. It has a dorsolateral angle where
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY
79
the inferior hypogastric wing and the rectovesical septum meet along the hypon-
gastric root. It also has a caudolatera! angle, where the inferior hypogastric wing
Fig. 12
Nerve supply of seminal vesicles and vas deferens
Same dissection as Figs. 10 and 11. Pelvic ganglion and its genito-urinary branches dissected out.
1) Vas deferens; vertical portion cut through and pulled medially. 2) Seminal vesicle pulled
medially. 3) Inferior hypogastric nerve in presacral wing. Lateral to it lies the hypogastric root
with the ureter in it. 4) Ureter in the inferior hypogastric wing. 5) Medial fascial leaf of inferior
wing lifted off the core of the wing and pelvic ganglion with its genito-urinary visceral branches
dissected out.
Same pelvis as Figs. 10 and 11 (479 , 1948, fig. 5). Dissection made by Dr. Edmund B. Mid-
dleton.
and the rectovesical septum meet along their common line of attachment to the
fascia endopelvina. The roof of the retrovesical space is formed by the supragenital
80
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
septum. It has no floor unless the cranial aspect of the posterior and middle lobes of
the prostate gland is considered as such; see Figure 9. This is because an angle is
formed where the rectovesical septum is attached to the prostate gland, between
the septum and the bladder. Strictly speaking, the retrovesical space extends caudally
only to this attachment between rectovesical septum and prostate. In cases in
DlA^^_
Fig. 13
Genital fascia
Peritoneum raised and cut away except at the bottom of the rectovesical pouch. Vertical por-
tion of ureter shelled out of fascia of hypogastric root, vas deferens cut where it crosses ureter.
Supragenital septum incised transversely and walls of retrovesical space spread apart to show con-
tents of space. Genital fascia separated from rectovesical septum; cranially it was attached in this
subject to peritoneum of rectovesical pouch along same line as rectovesical septum. The rectovesical
septum faded out into capsule on dorsal lobe of prostate gland. Ampulla of vas deferens shelled
out from in between the two layers of genital fascia.
1) Ureter in hypogastric root, accompanied by veins from vesical plexus. 2) Vas deferens in
superior hypogastric wing, cut where it crosses ureter and pierces supragenital septum to enter
retrovesical space. 3) Peritoneum of rectovesical pouch. 4) Rectovesical septum. 5) Capsule on dor-
sal bladder surface, continued into medial fascial leaf of inferior hypogastric wing. 6) Supragenital
septum. 7) Genital fascia. 8) Ampulla of vas. 9) Seminal vesicle. 10) Arteries entering retrovesical
space from inferior wing.
Left half of pelvis (479 , 1949, fig. 6) of colored male, 75 vears of age.
45
which the rectovesical septum extends caudally down to the pelvic floor, cutting
through this attachment leads into the retroprostatic space of Proust.
In Figure 2 the superior wing has been incised from dorsal to ventral. If the cut
margins of this slit are pulled apart, one is enabled to look down into the lateral
compartment of the space of Retzius. If a surgical needle is run through the lateral
wall of the retrovesical space, it will be seen to appear in the space of Retzius. The
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 81
retrovesical space is partitioned off against the lateral compartment of the space of
Retzius by the inferior hypogastric wing.
The Space of Retzius
The space of Retzius is also known under the names of "retropubic" and "pre-
vesical" space. In reality, this space is by no means confined to the retropubic region,
but extends laterally on either side between the inferolateral surface of the bladder
and the lateral wall of the pelvis, back to the spine of the ischium. It is composed of
a ventral and two lateral compartments. The lateral compartments are continuous
with one another through the ventral compartment.
The space of Retzius has a floor and a roof, a dorsal, a medial, and a lateral wall.
If the hand is pushed down between the bladder and the symphysis pubis, it is
stopped at the level of the caudal end of the symphysis pubis by the floor of the
space. If the hand is pushed backward between bladder and lateral pelvic wall, it is
stopped by the dorsal wall. The latter constitutes a firm obstacle which prevents
the hand from reaching the space behind the rectum.
In some cases an attempt to pull the bladder away from the symphysis pubis is
unsuccessful, owing to the presence of a sagittal septum which binds the keel of
the bladder to the symphysis pubis. While this septum is a constant structure which
divides the ventral compartment into a right and a left half, it is usually so thin that
it can easily be broken down with the fingers. In other subjects, however, it is so
stout, that it must be cut through with scissors before the bladder can be retracted.3
1. Dorsal Wall of Space of Retzius: The dorsal wall of the space of Retzius,
shown in Figures 5 and 6, is represented by the vertical portion of the common
anchorage line, the hypogastric root, and by the inferior vesical arch. Pushing one
hand into the lateral compartment of the space of Retzius against the hypogastric
root, and the other hand laterally as far as possible into the retrorectal space, will
demonstrate convincingly that the hypogastric root prevents the two hands from
touching each other. As it contains the ureter, one or several inferior vesical arteries
and several large veins, it represents an impenetrable partition between the space of
Retzius and the retrorectal space.
2. Floor of the Space of Retzius : The floor of the space of Retzius is formed by
the fascia endopelvina (Fig. 6). This fascia extends from the caudal end of the sym-
physis pubis to the spine of the ischium where it becomes continuous with the fascia
which covers the ventral surface of the hypogastric root. Its "appearance is, however,
not the same throughout its extent. If the bladder is pulled away from the symphysis
pubis and the lateral pelvic wall and a quantity of fat constantly present in the
space of Retzius is carefully cleaned away, the most conspicuous structure seen in the
floor of the space is a band (Figs. 2 and 5) of about 5 to 7 mm. width and of glistening
appearance. The bladder is firmly attached to the pubic bone and to the fascia of the
levator ani by this band. It is of varying length. In some subjects it can extend dorsally
for a distance of 60 mm. Dorsally, it ends constantly in a sharp crescentic margin
(Fig. 5). Dorsal to this margin, the fascia drops off to a lower level. It is of the usual
dull appearance of fascia and of varying stoutness and is thin and transparent in
many cases. In some subjects the whitish band may present, in addition so its most
dorsal crescentic margin, one or several similar margins farther ventrally, or dorsally,
82 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
to each of which the fascial band is continued at a lower level. In front, this band is
bordered by a similar arch-like margin, but with its concavity pointing in the opposite
direction. This ventral margin can be identified as a cord-shaped ligament, the pubo-
vesical ligament. This is separated from the rest of the band by a slit-like interval.
The band itself is known as the lateral true ligament of the bladder. Between the
pubovesical ligaments of the two sides, a depression is located which is covered over
with a thin fascia. Through this, the deep dorsal vein of the penis enters the pelvic
cavity (Fig. 2). In some cases, two pubovesical ligaments, a medial and a lateral,
are differentiated (Fig. 5). In the pelvis illustrated in Figure 2, the medial pubo-
prostatic ligaments were situated at a slightly more caudal level in the floor of the
depression between the two lateral puboprostatic ligaments.
Upon more complete dissection it is found that the 3 ligaments (medial and lateral
puboprostatic, and lateral true ligament of the bladder) are in reality covered by a
thin fascia which is continuous ventrally with the fascia that forms the bottom of
the depression between the medial puboprostatic ligaments, and dorsally with the
remainder of the fascia endopelvina. The true ligaments are situated below this
fascia and are of an aponeurotic nature, possessing a bluish sheen (Fig. 6). In the
case of the medial pubovesical ligament, smooth muscle bundles are intermingled
with the aponeurotic fibers.
There is also a difference in relationship between the ventral ligamentous portion
and the dorsal portion of the fascia endopelvina. By the ligamentous portion, the
fascia is directly inserted into the bladder or prostate gland. Dorsally, it serves as a
common anchorage line for the inferior hypogastric wing, the rectovesical septum,
and the presacral wing.
It has already been mentioned that the fascia endopelvina ends dorsally, opposite
the ischial spine, in a stout arch. The fascia which closes the space between this arch
and the inferior vesical arch contains no blood vessels and often can be broken down
with a finger, if communication between the space of Retzius and the retrorectal
space is desired. Moreover, the part of the fascia endopelvina extending from the spine
of the ischium to the dorsal end of the lateral true ligament of the bladder constitutes
an avascular area; an incision through it leads broadly into the retrorectal space.
Both routes are indicated by rubber tubings in Figure 6. Since the fascia endopelvina
in this avascular region is usually quite thin and affords little support to the bladder
and rectum, cutting through it does not materially interfere with the fixation of the
bladder, which is accomplished for the most part dorsally by the inferior vesical
arch and ventrally by the pubovesical ligaments and the lateral true ligament of
the bladder.
3. The Medial and Lateral Walls and the Roof of the Space of Retzius : These will
be discussed only briefly. The medial wall is represented ventrally by the infero-
lateral bladder surface; dorsally, by the inferior hypogastric wing. The lateral wall
is composed of the parietal fascia over the internal obturator and levator ani muscles.
The superior wall or roof is represented by the superior hypogastric wing.
The Retrorectal Space
The retrorectal space, as mentioned above, lies between the rectum and the sac-
rum. Dorsally, it is bounded by the parietal fascia which covers the piriformis,
coccygeus, and levator ani muscles. Its ventral wall consists, in the cranial part of
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY
83
the space, merely of the presacral wing. Farther caudally, however, where this fascia
embraces the rectum to form the fascial capsule of this viscus, the rectum covered by
the dorsal part of its capsule participates also in the formation of the ventral wall
of the retrorectal space. If, in an attempt to open up the retrorectal space, one
penetrates laterally, one arrives finally at the hypogastric root. This may be said
to form the lateral wall of the cranial portion of the retrorectal space and which
Fig. 14
Retrorectal space
Fibrous tissue which fixes the dorsal capsule of the rectum and the presacral hypogastric wing
to the parietal fascia was broken down with a blunt instrument. Fascial shelves conducting the
visceral nerves are displayed.
1) Fascial capsule on dorsal surface of rectum. 2) Presacral hypogastric wing. 3) Parietal fascia.
4) Cranial shelf. 5) Caudal shelf. 6) Bundle of visceral nerves in caudal shelf, passing to pelvic
ganglion.
Left half of pelvis (479 , 1950, fig. 2) of white male, 66 years of age.
partitions this space off against the lateral compartment of the space of Retzius.
Farther caudally, where the presacral wing attaches itself to the fascia endopelvina,
the retrorectal space has no lateral wall but terminated in an angle formed by the
presacral wing with the fascia of the levator ani.
A study of the retrorectal space in a sagittally divided pelvis is of interest. By
attempting to lift the presacral wing and the rectum away from the parietal fascia
and from the sacrum and coccyx, one observes that the visceral fascia and the capsule
of the rectum are firmly fixed to the parietal fascia by an abundant loose but tough
84
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
fibrous tissue. On probing into this tissue with a spatula-probe and penetrating
laterally, it will be found that constantly one or several fascial shelves remain. These
arise from the parietal fascia in the vicinity of the anterior sacral foramina and pass
■ y,;". -
Fig. 15
Pelvic ganglion
Fibrous tissue which attaches rectum and presacral wing to parietal fascia, broken down, visceral
nerves dissected out of fascial shelves (see Fig. 14) and followed to presacral wing. Presacral wing
split into its two fascial leaves and pelvic ganglion dissected.
1) Remnant of rectovaginal septum. 2) Ventral capsule of rectum and its continuation into ven-
tral leaf of presacral wing; the latter has been cut away down to a narrow strip. 3) Dorsal capsule
of rectum and its continuation into dorsal leaf of presacral wing; the latter has been cut down as
far laterally as the line along which the visceral nerves enter the wing. 4) Pelvic ganglion. 5) Inferior
hypogastric nerve.
Right half of pelvis (479 , 1946, fig. 9) of colored female, 29 years of age.
forward and downward to join the presacral wing and the rectal capsule. Even on
casual inspection, a number of substantial nerve tracts are seen running in these
fascial shelves. They are the parasympathetic branches of the sacral nerves and
several branches from the sympathetic ganglia. Figure 14 illustrates a pelvis in
which two such fascial shelves were present. The lower one was particularly large
UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 85
and well developed. In it, the visceral nerves were arranged into a wide band-shaped
bundle and were visible even before any further dissection was made.
In Figure 15, a female pelvis is shown in which the individual nerves enclosed in
these fascial shelves have been dissected out. They were followed from their origin
to the pelvic ganglion which they are seen to join. The two layers of the presacral
wing were separated from one another and the ganglion was exposed. The pelvic
ganglion lies embedded in the presacral wing, close to the lateral attachments of this
wing. Its cranial tip lies about at the level of the ischial spine. The illustration shows
that the nerves for the urogenital tract are given off from the cranial parts of the
ganglion. They pass into the inferi&r wing and are conducted in that part of the
visceral fascia to the uterus and bladder in the female. In the male they go to the
seminal vesiclas, ampullae of vasa deferentia, prostate and bladder. In Figure 7,
two stout visceral nerves are seen as they enter the inferior hypogastric wing to be
conducted to the urogenital organs. The nerves for the rectum arise from the caudal
portion of the ganglion, pass into the space between the fascial capsule and the
muscular wall of the rectum, and are distributed from there to the wall of the rectum.
The Author wishes to acknowledge his indebtedness to Dr. Albert E. Goldstein through whose
generous interest the American Urological Association and private donors have contributed funds
which made available the artistic assistance of Mr. William E. Loechel.
BIBLIOGRAPHY
1. Cameron, John: The fascia of the pelvis. Jr. Anat. and Phys., XLII, 112-125. 1908.
2. Denonvilliers : Anatomie du perinee. Bull, de la Soc. Anat. de Paris, II, 105-107. 1836.
3. Derry, Douglas E.: On the real nature of the so-called "pelvic fascia," Jr. Anat. and Phys.,
XLII, 97-106. 1908.
4. Lowsley, Oswald Swinney and Kirwin, Thomas Joseph: Clinical Urology, 2nd edition, Wil-
liams and Wilkins, Baltimore, 1944.
5. Peham, H. v. and Amreich, I.: Gynaekologische Operationslehre, S. Karger, Berlin, 1930.
(Also available in an American translation by L. Kraeer Ferguson, J. B. Lippincott, Phila-
delphia, 1934.)
6. Smith, G. Elliot: Studies in the anatomy of the pelvis, with special reference to the fasciae
and visceral supports. Jr. Anat. and Phys., XLII, 198-218. 1908.
7. Uhlenhtjth, Eduard, Wolfe, Walter M., Smith, E. Milton, and Mdjdleton, Edmund B.:
The rectogenital septum. Surg., Gynec. & Obst., LXXXVI, 148-163. 1948.
8. Young, Hugh H. and Davis, David M.: Young's Practice of Urology. Saunders Company,
Philadelphia, London, II, 420, 1927.
FOOTNOTES
1 Among the 60 illustrations which have been collected so far, we owe the great majority to Doc-
tor Edmund B. Middleton who holds the rare record of combining in one single person the enthu-
siasm of a student, the skill of an anatomist and the gift of an artist.
2 In a male pelvis dissected most recently, however, the supragenital septum was fully §" thick,
composed of strong fibrous tissue and of some fat.
3 In one case (479 , 1949, colored male, 75 years of age) which was anomalous in several other
respects, this septum consisted of two strong lamellae, between which a space of nearly \" width
was enclosed. Each lamella was the continuation of the inferolateral bladder capsule of the corre-
sponding side and was continued into the parietal fascia on the pelvic wall. In the area between
the lines of origin of the two lamellae from the bladder, the surface of this viscus was completely
naked, the muscle being freely exposed. It is probable that this septum consists also under the
usual conditions of two lamellae, but cannot be split because of its thinness.
THE RELATION BETWEEN pH CHANGES AND RABBIT GUT MOTILITY
IN VITRO *f
LEAH MILLER PROUTT, B.S., E. RODERICK SHIPLEY, M.D., ROBERT H.
OSTER, Ph.D. and J. EDMUND BRADLEY, M.D.
The general qualitative effect of pH variation on the activity of smooth muscle has
been well established (1-7). In the present work, quantitative measurement of
pH changes in relation to rabbit gut motility in vitro as modified by various agents
including several beverage syrupsj have been made to determine the degree of corre-
lation between these two variables.
The possible importance of pH and its effect on smooth muscle motility in vivo
was indicated by the recent clinical observations of one of the authors (J. E. B.)
on the use of a beverage syrup and a glucose phosphoric acid syrup in epidemic vomit-
ing of children (8, 9). Gorman et al (1) have demonstrated that hydrochloric acid
inhibits or arrests contraction of isolated gastric muscle of the rabbit and that
sodium citrate and sodium bicarbonate restore the tonus. Evans and Underhill (3)
have noted that smooth muscle is very sensitive to alterations in the hydrogen ion
concentration and that a lowering of the hydrogen ion concentration causes an in-
crease in tonus and an increase in rate of rhythmic contractions, and a raising of the
hydrogen ion concentration causes the opposite effect. The data obtained in the
present study include simultaneous pH measurements and smooth muscle motil-
ity as measured by contraction rate in the presence of various agents used to alter
the pH.
During the early stages of the experiment, it was noted that the specific gravity
definitely affected the amplitude of smooth muscle contraction in vitro. In Table I
may be seen a comparison between amplitude and contraction rate as modified by
specific gravity changes using control solutions. Because of the wide fluctuation of
mean amplitude values, as compared with the narrow contraction rate value range,
the latter was selected as the indicator of pH effects on smooth muscle activity.
Since sugar was present in beverage syrups, rigid control of specific gravity was not
possible. Table I presents the mean values of all the effects of control solutions on
gut motility.
MATERIAL
A rabbit in the fasting state was killed by a blow at the base of the brain, im-
mediately eviscerated and the intestinal sections were flushed several times with
Tyrode's solution,. (10) then placed in clean Tyrode's and kept under constant
aeration at 12-20 degrees C., with frequent changes of the solution.
METHOD
A modified Magnus technic (5) was used. Intestinal sections one to one and one-
half inches long were cut, and mounted in the muscle chamber with as little handling
* From the Department of Physiology, School of Dentistry, and Department of Pediatrics,
School of Medicine; University of Maryland, Baltimore, Maryland.
t Received for publication November 30, 1950.
\ The beverage syrups were kindly supplied by the National Carbonated Beverage Company.
86
PROUTT ET AL.—IL4BBIT GUT MOTILITY
87
as possible. Two sutures were used on each end of the section, in order to insure
holding the lumen of the gut open. One end was attached to the standard in the
muscle bath, and the other to the muscle lever. The temperature was automatically
controlled at 39.5 degrees C, ± 0.5 degrees C. and aeration with room air was
constant. The muscle section was at all times immersed in 100 cc. of solution, the
major portion of which was Tyrode's solution and the final volume of the muscle
bath was kept constant at 100 cc, since any agent added to the bath was compen-
sated for by a withdrawal of a corresponding amount of Tyrode's. The muscle
section was washed with fresh Tyrode's at 39.5 degrees C. after each experimental
TABLE I
The effect of the control solutions on rabbit gut motility, showing the individual and mean values of
per cent change of experimental from the normal
AMPLITUDE
RATE OF CONTRACTION,
PER MIN.
pH
SOLUTIONS
Spec.
Grav.
nor.
change
% diff.
nor.
change
% diff.
nor.
% diff.
mm.
mm.
Tyrode's
1.008
76
76
0
13
13
0
7.02
-0.2
1.008
40
40
0
11
11
0
7.505
0
1.006
6
9
33
12.5
10.5
16
8.92
-1.0
1.008
9
10
10
10.8
10.8
0
8.00
5.0
1.008
11
13
18
11.5
10.5
-9
8.00
-1.0
1.008
13
12
-13
10.5
10.0
-5
7.80
1.0
1.008
15
15
0
13
13
0
7.72
0.3
Mean
20 to -13
— 5
3 to -5
Sugar, 3%
1.015
59
34
-42
13
11
-15
7.42
-0.3
Sugar, 2.7%
1.014
76
38
-38
13
11
-15
7.00
-0.2
It
1.014
53
35
-34
10
8
-20
7.86
-0.7
It
1.014
40
6
-85
15
14
-6.5
7.77
1.0
it
1.016
40
16
-60
11
11
0
7.50
0.5
it
1.014
18
5
-72 ■
10.5
10.5
0
7.42
2.0
a
1.014
12
5
-56
10.0
9.5
-9.5
7.88
1.0
a
1.014
9.6
5.3
-45
12.5
11.5
-8
a
1.015
17
8.6
-50
12
12
0
7.75
1.0
Mean
-56
-9.3
1 to -0.5
step, and fresh solutions were used for each experimental step. Muscle contractions
were recorded on a constant speed kymograph drum, and the rate of contractions
could be accurately calculated at any spot on the record by using the simultaneously
recorded time of one mark per second. The pH readings were taken simultaneously
with muscle contraction change by the use of a glass electrode, in situ, immersed
next to the muscle section in the tissue bath, and read with a Beckman electronic
pH meter.
SOLUTIONS
The solutions used and their initial pH are given in Table II.
88 BULLETIN OF THE SCHOOL OF MEDICINE, V. OF MD.
DISCUSSION
It should be noted that the isolated muscle strips were immersed in the test solu-
tions in such a manner that both the serous coat and, to a much less degree, the
mucous membrane were in direct contact with the solutions. The changes that oc-
curred upon altering the pH were the result of the solutions contacting both surfaces,
but the absorption across the mucous membrane obviously played a minor role.
Magee and Southgate (7) have shown that motility of isolated rabbit and cavy
intestines were unaffected by varying the hydrogen ion concentration, from 1.5 to
TABLE II
Experimental solutions used to determine the ejfect of varying pH on rabbit gut motility
0.0165% HC1
0.192 H3PO4
8.5 H3P04
25.0 Sugar
2.84 Na2HP04....
2.0 NaHC03
A cola syrup
B cola syrup*
Citrus syrup
Kola (1 ) syrup
Kola (2) syrup
Kola (3) syrup
Kola (4) syrup
Lemon syrup
Orange syrup
Grape syrup
Ginger Ale syrup gold
Ginger Ale syrup pale
Root Beer syrup
Coca leaf extract (Merck)
Kola nut extract (Lilly) t-
INITIAL pH
0.82
1.12-2
1.02
6.58
8.96
8.72
1.58
1.88
1.56
1.80
(id
56
70
86
25
38
90
45
22
10
6.02
5.52
* A and B cola syrups are samples from soft drink fountain supplies of Coca-Cola and Pepsi
Cola syrups.
t We are indebted to Eli Lilly and Company for the kola nut extract.
9.6 within the lumen, but when the mucous membrane was destroyed, increased
acidity resulted in a marked depression of motility.
In experimental results on in vivo preparations, the depression of gastric motility
in correlation with an increase in the hydrogen ion concentration has been found by
many investigators (12, 13, 14), but evidence for a similar effect on tissue of the
small intestine is difficult to find.
The observation of this correlation between pH change and intestinal motility
confirms many previous reports and further presents the correlation graphically
(Fig. 1). It is felt that the pH data obtained simultaneously with muscle activity
changes by the in situ electrode, and the variety of agents employed to change the
PROUTT ET AL.— RABBIT GUT MOTILITY
89
pH make it possible to present quantitative evidence for the correlation in the form
of a scatter diagram.
The increase in hydrogen ion concentration, giving a lower pH, which stimulated
tone and then decreased contraction rate if continued, gave aspects which were
reversed by a decrease in hydrogen ion concentration, resulting in a higher pH.
Alkalinity at first stimulated the gut and increased the amplitude, then decreased
the contraction rate if continued to excess. This decrease in contraction rate with
fiber shortening was observed by McSwiney and Norton (6), who capably summarized
Fig. 1. The distribution of values obtained on rabbit gut motility effects of numerous agent
used to vary pH are shown in a scatter diagram. The linear relationship of the two variables indi
cate the positive correlation between muscle strip contraction rate and pH of tissue bath.
these findings by saying that while moderate pH changes had the specific effects on
intestinal motility (i.e., acidity depresses and alkalinity stimulates), the effect of
sudden great shifts in pH is the same regardless of the direction of the hydrogen ion
concentration change; initial stimulation, followed by marked depression. Mc-
Swiney and Norton's optimum pH range for normal motility in rabbit gut was
7.0-8.0, which was confirmed by observations of an optimum of 7.2-8.4.
A slowing of the contraction rate occurred regardless of the acid used to lower the
pH. Hydrochloric acid, hydrochloric acid and sucrose, phosphoric acid, phosphoric
acid and sucrose all gave similar reductions in the rate of contraction. It was noted
90
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
that hydrochloric acid brought about this change in less time and to a greater degree
than phosphoric acid at approximately the same pH, and that alkaline stimulus
following the acid effect caused greater response when the acid containing the
phosphoric acid had been the depressing agent. The kymograph records showing
this effect may be seen in Fig. 2. The motility depression was not significantly
changed when the acid agent used was in sucrose solution, except when the viscosity
of the tissue bath, determined as specific gravity, exceeded the control range of
values. (See Table I.)
As may be seen in the graph of Fig. 1, the contraction rate, always expressed as
per cent change of an experimental record from a normal record, was sensitive to pH
changes, also expressed as per cent change of experimental from the normal. This
change followed the same direction, regardless of the agent used, i.e., increase on
hydrogen ion concentration contributed to a decrease in motility and decreased
+ 10 0 -10
PERCENT CHANGE
Fig. 2. Typical rabbit gut motility records show the effect of two agents used for pH change,
hydrochloric acid and phosphoric acid. Differences in contraction rate effect over similar pH range
may be noted.
hydrogen ion concentration contributed to an increase in motility. The various kola
beverage syrups used as acid agents followed the same trend, but with an added
depressant effect beyond that possible from acidity effect alone. Kola nut and coca
leaf extracts when used, without acid, caused a marked inhibition of contraction
rate with only a low per cent decrease in pH. When the extracts were used in acid
solution, the resultant values of motility depression fell outside the range of the cor-
relation curve. (Not plotted in Fig. 1). The contraction rate inhibition was found to
be uniformly more marked and appeared earlier when the beverage syrups* were
used as the acid agents. This consistent change may be the result of components
present in the beverage syrups that have further depression effect on gut motility
than that attributed to acidity alone. In the case of kola syrup, perhaps the extracts
of kola nut and coca leaf are responsible.
* Beverage syrups include lemon, orange, gingerale, root beer, citrus and grape, as well as the
kola varieties.
PROUTT ET AL.— RABBIT GUT MOTILITY 91
SUMMARY
1. The effects of hydrogen ion concentration variation in acid solutions and
beverage syrups are demonstrated on rabbit gut smooth muscle in vitro with simul-
taneously recorded motility and in situ pH values.
2. The distribution of the data on a scatter diagram demonstrates the linear
relationship indicative of positive correlation.
3. Our data confirm previous reports; within moderate range, acids inhibit and
alkalis stimulate smooth muscle motility.
4. Hydrochloric acid solutions have a more marked effect than phosphoric acid
solutions at the same pH.
5. Sodium bicarbonate and disodium phosphate have similar effects on muscle,
i.e., stimulation of motility.
6. Kola beverage syrups have a depressant effect on muscle motility, and show
greater depression than may be attributable to the acid content alone, indicating
the possible presence of other depressing agents.
7. Stimulatedbeverage syrups, such as hydrochloric acid and sucrose, phosphoric
acid and sucrose, depress the motility of the gut in proportion to their acidity.
Non-kola beverage syrups have a lesser depressant effect than the kola syrups.
BIBLIOGRAPHY
1. Gorman, R. A., Drier, J. D., Rehfuss, M. E.: A study of the effects of acids and alkalis on
gastric muscle strips in rabbits. Am. J. Surg. 12: 121, 1931.
2. Evans, C. L.: The physiology of plain muscle. Physiol. Rev. 6: 358-398, 1926.
3. Evans, C. L., Underhiix, S. W. F.: Studies on the physiology of plain muscle. J. Physiol. 58:
58-91, 1923.
4. Sollmann, T., Von Oettingen, W. F., Ishikawa, G.: The effects of phosphate buffers on
intestinal movements and their interrelation with calcium. Am. J. Physiol. 87: 293-305,
1928.
5. Magee, H. E., Reid, C. : Studies on the movements of the alimentary canal; the effects of
electrolytes on the rhythmical contractions of the isolated mammalian intestine. J. Physiol.
63:97-113, 1927.
6. McSwiney, B. A., Newton, W. H.: Reaction of the smooth muscle to the H-ion concentration.
J. Physiol. 63: 51, 1927.
7. Magee, H. E., Soitthgate, B. A.: Influence on intestinal movements of electrolytes in the
lumen of isolated segments. J. Physiol. 68: 67-79, 1929.
8. Bradley, J. E.: The treatment of epidemic vomiting in pediatric practice. J. Pediat. 33: 318-
324, 1948.
9. Bradley, J. E., Proutt, L. M., Shipley, E. R., Oster, R. H.: An evaluation of a carbohydrate
phosphoric acid solution in the management of vomiting. J. Pediat. 38: 41-44, 1951.
10. Macleod's Physiology in Modern Medicine, revised by Philip Bard: 9th Edition, 349; C. V.
Mosby and Co., 1941.
11. Luciani, Luigi: Human Physiology, 2: 245-248; McMillan and Co., 1913.
12. Wolf, Stewart; Wolff, H. G.: Human gastric function, 2nd. ed. 66-89, Oxford Univ. Press,
1947.
13. Thomas, J. E.; Crider, J. O.: Inhibition of gastric motility associated with the presence of
products of protein hydrolysis in the upper small intestine. Am. J. Physiol. 126: 28-38, 1939.
14. Karr, W. G., Abbott, W. O.: Intubation studies of human small intestine. IV. Chemical char-
acteristics of contents in fasting state, normally, and after administration of acids, alkalis
and water. J. Clin. Invest. 14: 893-900, 1935.
CLINICO-PATHOLOGIC CONFERENCE
From the Case Histories, University Hospital, Baltimore
CLINICAL HISTORY
A 57 year old white male mechanic was admitted to the University Hospital on
April 4, 1950, because of weakness and numbness of his left leg of one weeks' dura-
tion. Constipation and difficulty in voiding appeared 2 to 3 days before admission.
Acute urinary retention occurred 12 hours before arrival at the hospital. He stated
that he had previously enjoyed good health. About 2 weeks prior to admission, he
developed a mild cold which was characterized by a slight cough, productive of
small amounts of white phlegm. He suffered an ache in the right ear from which pus
drained. The patient was seen by his family physician who gave him 3 daily injec-
tions of penicillin. The purulent discharge decreased but did not cease.
One week before admission the patient noted sudden, tight, "girdle" pains and
numbness of his left leg. Subsequently, he was aware of increasing weakness of his
left leg, constipation, and increasing difficulty in voiding. There was no history of
headache, vertigo, coma, paralysis, anaesthesia, or paraesthesia. Although this
history was given readily, its accuracy is questioned because the patient's memory
and intelligence were considered below normal.
The patient's habits were indulged in moderately. He drank 2 or 3 glasses of beer
and smoked 20 cigarettes each day. His employment had been steady for 32 years.
Six months before admission, he sustained a low back injury after wffiich he limped.
On admission, he appeared chronically ill. There was no evidence of weight loss
or acute distress. There was no rash, evidence of jaundice, petechiae, or dehydra-
tion. His temperature was 98.6 F.; pulse rate, 88 per minute; and respiratory rate,
18 per minute. His pupils were round, regular, equal, and reactive. The fundi were
normal. The right eardrum wras perforated. The auditory canal was filled with a
thick, odorless, white exudate. There was no mastoid tenderness. The nose and
sinuses were normal. The teeth were in poor repair. Slight pharyngeal injection was
seen. The tonsils were considered normal. There was no venous distention in the
neck. The trachea was in the midline. There was no tug. In the right submental
region, there was a hard, painless, freely movable eliptical lymph node of about 4
cm. in length. The chest expanded well. The lungs resonated on percussion of the
chest. The breath sounds were vesicular. There was no increase of retro-manubrial
or cardiac dulness. The heart sounds were normal in rate, rhythm, and intensity.
The systolic blood pressure was 150 mm. of mercury; the diastolic, 90. The abdomen
was flat, symmetrical, and relaxed without tenderness. No organs or masses were
palpable. The genitalia were normal. The anal sphincter tone was fair. There were
no hemorrhoids. The prostate gland was moderately enlarged, soft in consistency,
and free of masses. Feces on the examining finger were normal in appearance. There
was no dependent edema. Pulses in the feet were good. There was no bony tender-
ness.
A consultant in neurology found the patient to be alert and cooperative. Hearing
was impaired in both ears, but the impairment was greater on the right side. There
92
CLIN I CO-PATHOLOGIC CONFERENCE 93
was complete anesthesia on the left side below the 10th thoracic segmental level.
The right leg and both upper extremities were normal. Motor power was intact ex-
cept in the left lower extremity which was weakened to such an extent that the
patient could barely lift his heel from the bed. The deep tendon reflexes were hyper-
active and equal in both upper and lower extremities. There was no pathologic
reflexes.
On admission the blood hemoglobin concentration was found to be 90 per cent.
This fell in 1 month to 70 per cent. Moderate leucocytosis was identified. Blood
sugar, urea nitrogen, albumin, globulin, direct and indirect bilirubin, calcium, and
phosphorus were determined to exist in normal concentrations. Thymol turbidity
was reported to be .94 units; blood alkaline phosphatase, .6 units; and blood acid
phosphatase, .65 units. The plasma chlorides and carbon dioxide combining power of
the serum was normal. Sputum specimens and gastric washings were studied for
Mycobacterium tuberculosis, but none was found. Blood cultures were sterile.
Cultures of material from the ear grew E. coli and staphylococcus; from the sputum.
Diplococcus pneumonia and Streptococcus viridans. Heterophile and cold agglutinins
were not demonstrated. A catheterized urine specimen contained 10 white blood
cells and innumerable red blood cells. Absolute bed rest was ordered. A lumbar
puncture was not attempted.
A roentgenogram of the chest showed an area of increased density, measuring
3 cm. in diameter, lying behind the right fifth rib near the periphery of the lung
field (Fig. 1). It appeared rarefied in its superior portion. There was pleural thick-
ening in the region of the right lateral thorax and the right interlobar fissure. The
dorsal and lumbar vertebral bodies were normal. An area of rarefaction, 1 cm. in
diameter, was seen in the left ileum (Fig. 2). At the junction of the inferior ramus
of each ischium with the acetabula, there was an ill-defined area of decreased density.
This was most marked on the right side. On April 5 definite weakness of the right
lower extremity was noticed. The left remained about the same.
An examination on April 6 revealed bilateral hyperasthesia at the level of the
tenth thoracic segment. There was no spinal tenderness. There was almost complete
anesthesia on both sides below the thoracic level. There was no muscle power of
either lower extremity or the abdominal muscles below the umbilicus. There was
loss of autonomic control. The reflexes were equally active in the upper extremities,
very sluggish in the left lower extremity, and absent in the right. There was bi-
lateral plantar extension and flexor withdrawal movements.
Because of the progression of this illness, a laminectomy was performed. At opera-
tion a definite lesion was not found. The operator felt that neither the bone nor the
epidural fat in the exposed area appeared normal. Biopsies of both were taken.
Subsequent microscopic examination found the bone and adipose tissue to be nor-
mal. The spinal cord in the area of the laminectomy appeared white and lifeless.
The overlying vessels were sclerotic. A catheter was easily passed up and down over
a distance of about 6 cm. Following laminectomy, there was no improvement of
the motor and sensory impairment.
A neurologic examination on April 10 revealed evidence of progression of neurologic
disease. At that time, in addition to complete paraplegia and anaesthesia, there
94 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
was definite weakness and awkwardness of the upper extremities and hypoactivc
reflexes. Speech was slurred, and there was some difficulty in swallowing food and
liquid. The tongue protruded in the midline, the gag reflex was active, and the
uvula elevated normally. Direct laryngoscopy showed approximation of the vocal
cords to the right of the midline.
A lumbar puncture on April 13 revealed xanthochromic spinal fluid. The intra-
spinal pressure was normal. One hundred erythrocytes and twenty-five leucocytes
were found in each cubic millimeter of spinal fluid. The protein concentration was
158 mgm. per 100 cubic centimeters.
Over the next 2 weeks, the patient's course was marked by increasing drowsiness
and stupor. His upper extremities finally became completely paretic. During this
period he was given penicillin and parenteral fluids. Terminally, he developed fever,
leukocytosis, and irregular respiration with many moist rales in the chest. He ex-
pired quietly on May 4, 1950.
CUNICAL DISCUSSION
Dr. M. C. Pincqffs: If this patient had complained of only weakness and numb-
ness of his left leg, one might have thought of injuries involving the nerves of the-
leg, but the onset of constipation, difficulty in voiding, and acute urinary retention
indicate something involving more than the peripheral nerves or the nerve roots.
The question is whether this infection of the respiratory tract involving the middle
ear was a coincidence or was related to the appearance within a week or two of damage
to the nervous system. We know that the running ear was treated with penicillin.
The majority of infections of the middle ear are by gram-positive cocci. This makes
one suspect that there was involvement of the mastoid cells. Such an infection
would not respond so readily to treatment. One inquires as to the things which link
acute upper respiratory infections with the central nervous system. You recall
that a few cases of meningitis are preceded by acute respiratory infections. The
meningococcus may be cultured from a nasal discharge in a case of meningitis. Re-
member that brain abscesses not infrequently are accompanied by a middle ear
involvement. This obviously is not brain abscess. I remember that on a number of
occasions we have seen in this hospital staphylococcal infections followed by an
abscess in the epidural space outside the dural covering of the spine. Such a mass
may press on the spinal cord and produce either a paraplegia or a hemiplegia. The
first case of this condition diagnosed and surgically treated in this country was
reported from the University Hospital, University of Maryland. We have subse-
quently had a special interest in extra-dural abscess of the vertebral column. As a
result, we have a rather large series of cases recorded in this hospital.
There is one point in the "review of systems" to which I call attention. It says
there that there was no bone pain or tenderness. You note above, that so far as
the legs are concerned, there is surprisingly little said about pain in the leg that
became numb and weak. It was noted, however, that the patient had some girdle-
like pain around his midsection. These findings urge a consideration of an epidural
abscess. Epidural abscess is characterized usually by severe pains ellicited by pressing
CLINICO-PATHOLOGIC CONFERENCE 95
on the nerve roots. There is usually a history of stiff back or pain on moving the back .
Often there is pain on coughing. The admitted total absence of pain is against that
diagnosis.
It is difficult to describe a tactile impression so one cannot fully appreciate the
adjective "hard" which modifies the submental lymph node. The node was obvi-
ously not a soft mushy one. It was probably of cartilaginous hardness which you
note in the glands of Hodgkin's disease or leukemia. There is a degree of hardness
which, in my experience, is always connected with either calcified glands or ones
packed with carcinoma. Not every carcinomatous gland has that hardness; but
when you feel a certain consistency, you can be fairly sure that it is carcinoma.
I do not get that impression from this description. I cannot recall a special reason
for a single very hard gland in that region. There was enlargement of other glands
in the cervical chain. It is the non-specificity of the results of this physical examina-
tion and the positive roentgen examination that lead some men to think that all
that is needed is the roentgenograph. This is as ridiculous as saying that all you need
is a physical examination. You need both. Here is confirmation of that fact.
It is interesting to note that there was no disturbance in sphincter tone, even
though the patient was developing a paraplegia. One might expect either hardening,
a tighter tone, or complete relaxation. In an older man, one of the most common
carcinomas is of the prostate gland. This malignancy has a tendency to metastasize
to the bones of the spine and result in partial collapse of a vertebra and pressure
on the spinal cord. This often results in paralysis. Therefore, one would want par-
ticularly to feel the prostate. In this case, it showed no evidence of malignancy.
Even so, malignancy of this gland cannot be dismissed. Over and over again you
will hear of enlarged prostates that felt benign, and were classed as benign. Later,
bone metastases appeared. In such an event, if the specimen is carefully recut, a
small area of carcinoma will be found. Never feel sure, if prostatic malignancy is
to be eliminated on palpation alone.
This patient had a sensory loss and motor paralysis of approximately the same
extent on the same side. If he had had a motor weakness on one side and sensory
impairment on the other, hemisection by pressure would be considered. There was
no evidence of an upper motor neuron lesion affecting the left.
In a month's time this patient's hemoglobin fell from 98 to 70 per cent. His blood
calcium and phosphorus concentrations were normal. Neither his alkaline phos-
phatase nor his acid phosphatase was elevated. These are raised in any destructive
primary lesion of bone and in cancer of the prostate with bony metastasis.
Note that the sputum cultures were positive for diphtheria. You know that in
the Pacific and other parts of the world, some cases of diphtheria do not have just
pharyngeal paralysis, but also develop paralysis in the extremities. Failure to perform
a lumbar puncture suggests that diphtheritic myelitis was not implicated. We note
that they later changed their minds.
Dr. Walter L. Kilby: This first film of the chest was made at the time of the
patient's admission. One can see that his lung is quite emphysematous. There is
pleural thickening at the apex. There are two lines representing the interlobar
96 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
pleura of the upper and middle lobes. There is a triangular area of infiltration in
the hilum. Just what this means I do not know. It may be fibrosis from some previ-
ous pulmonary infection. We are always concerned with these infiltrations in the
hilum because they might be indicative of early primary bronchogenic carcinoma.
The very small insignificant-appearing lesions in lungs may turn out to be early
carcinoma of the lung with widespread metastases. It does not appear to be a con-
solidating lesion spreading out from the hilum. In this right 5th rib, there is a small,
round, poorly circumscribed area of infiltration. In the center, there appears to be a
small area of rarefaction. I thought it was a lung abscess. This area of infiltration
by the 5th rib was still visible one week later. Films of the dorsal spine, the lumbar
spine, and the pelvis failed to show erosion or rarefaction. There is calcification of
the abdominal aorta.
In the pelvis there were several indefinite areas of calcification. Note the small
area of rarefaction in the ischium near the attachment to the acetabulum. This
does not necessarily mean a metastatic lesion, but it certainly seems to be worth
consideration. The trabeculae are not very prominent. These roentgenographic
findings are compatible with bronchogenic carcinoma.
Dr. M . C. Pincoffs: In the face of signs suggesting a lesion pressing on the spinal '
cord, it was obviously reasonable to do a laminectomy. However, at operation,
nothing was found except a cord that appeared white and lifeless. The underlying
vessels were sclerotic. Something had transected the cord. The operator was able
to pass a catheter up and down over a distance of about 6 cm. The vessels were
sclerotic. How often does one get a transection of the cord by a thrombus? Throm-
bosis may be predisposed by arteriosclerosis, but not commonly. In vascular syphilis
of the spinal cord, paraplegic lesions may develop. In this case a serologic test for
syphilis was not recorded.
Without much pain, this man had developed anesthesia of one leg and then the
other. Within a week or so, he had trouble in his arm. After that he became stuporous
and comatose. He had no fever, no increased cell count in his spinal fluid, no pain,
or muscle spasm. It seems to me that all the usual things — virus infections and
whatnot — are all unlikely. Infectious polyneuronitis, supposedly of virus origin,
though it usually does not cause complete paraplegia, might resemble the disease
this patient had.
What evidence is there against carcinoma as the diagnosis in this case? There
is no overwhelming evidence against it. There is a hard node in the neck, there are
suspicious lesions in the pulmonary hilum, and there are radiolucent areas of bones
that could indicate metastases. Bronchogenic is the type of carcinoma that has the
greatest tendency to metastasize to the central nervous system. One in 10 or 15
cases of bronchogenic carcinomas may metastasize to the central nervous system.
Certainly, this malignancy metastasizes more commonly to the brain than to the
cord. As a matter of fact, metastasis of carcinoma to the cord is very rare. The
absence of pain suggests that the lesion is inside the cord and not outside pressing
on the cord. I have seen just one such carcinoma in my lifetime. The rarity of such
a condition is against the diagnosis of bronchogenic carcinoma, with metastasis in
the spinal cord.
CLIN I CO-PA T HO LOGIC CONFERENCE
97
Fig. 1
Fig. 2
98 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Hypernephroma is a type of tumor that produces this kind of metastasis in the
lung. It sometimes metastasizes to the central nervous system. I believe that car-
cinoma with metastasis is a diagnosis which is feebly supported by the observations
in this case. I think it more reasonable to conclude that this patient's illness was
caused by an ascending myelitis. I am inclined to put carcinoma with metastases
to the spine in second place.
Senior Student: Is the serologic test for syphilis still unknown?
Dr. H. R. Spencer: That is still unknown.
PATHOLOGIC FINDINGS
Dr. H. R. Spencer: This was the body of a fairly well developed, poorly nourished,
56 year old white male. There was moderate atrophy of the musculature of the
lower extremities. Decubiti were seen on both hips, heels, lateral surfaces of the
ankles, elbows, scapular areas, and over the sacrum. A firm lymph node was palpated
in the anterior part of the posterior triangle on the right side of the neck. There was
a healed surgical wound in the midline of the back over the lower dorsal vertebrae.
The abdominal viscera appeared normal in size and position.
The pleural sacs contained no excess free fluid. The right lung was bound to the
parietal pleura by numerous dense fibrous adhesions. The pleura of the left lung
was smooth and glistening. Sectioning of the right lung revealed a firm yellowish-
white tumor mass in the lower main bronchus, the mass measuring about 3 cm. in
diameter. It partially obstructed the bronchus. A small abscess was seen in the
right lower lobe. The left lung appeared normal.
Except for slight sclerosis of the coronary arteries, the heart was normal. No
unusual changes were noted in the liver, the gastrointestinal tract, or spleen. The
kidneys were normal in size. Each was studded with tumor nodules. A yellowish
white tumor nodule was seen in the left adrenal. The periaortic lymph nodes in
the lumbar area were enlarged and invaded by tumor. A metastatic lesion was seen
in the body of the third lumbar vertebrae.
Small tumor nodules were scattered through the white and grey matter of the
cerebellar hemispheres, in the cerebrum, and in the brain stem. The lumbar portion
of the spinal cord was removed. Sections revealed a small tumor mass occupying
the center of the spinal cord. The lesion occupied about 75 per cent of the cross
section area of the cord for a distance of about 1.5 cm. Sections of the primary
tumor in the lung and from the metastases showed a poorly differentiated adeno-
carcinoma.
This case is an example of the tendency of bronchogenic carcinoma to metastasize
to the central nervous system, particularly the brain, adrenals, and bone. It also
shows that numerous metastases may occur in cases where the primary tumor is
small.
ANATOMIC DIAGNOSIS
Bronchogenic carcinoma, lower main bronchus, right, with metastases to regional
nodes, periaortic nodes, spinal cord, brain, adrenal, kidneys and spine.
OBSTETRICAL CASE REPORT
From the Department of Obstetrics, School of Medicine University of Maryland
M. S., a 26 year old, para 1-0-0-1, reported for care early in her second pregnancy. The only
significant fact obtained in her past history was that during the first pregnancy, 5 years previous,
it was noted that the blood pressure was moderately but persistently elevated, averaging about 136
mm. mercury systolic and 90 mm. mercury diastolic. There was no increase in blood pressure
during the last trimester of the pregnancy. The urine on one occasion showed a small amount of
albumin. The eye grounds were normal. The blood chemistry was essentially normal. Labor oc-
curred spontaneously at term and was uncomplicated. Postpartum, there was no change in the
blood pressure.
Following this pregnancy, she was under the care of an internist who reported a slight increase
in the blood pressure, but no other signs or symptoms of disease except for an occasional mild
albuminuria. When first seen in this her second pregnancy, five years later, the pressure was 140
mm. mercury systolic and 96 mm. mercury diastolic, the physical examination being otherwise
negative. She was observed rather closely throughout her pregnancy and followed the anticipated
course in that there was a mid-pregnancy drop in blood pressure, followed by a rise in the latter
weeks to a point slightly above earlier readings (146/100) with a definite albuminuria on 3 oc-
casions. Again, labor, delivery, and puerperium were without incident; and again the postpartum
blood pressure did not fall to any appreciable extent. Except for occasional albuminuria, all labo-
ratory examinations were negative, but the eye grounds showed evidence of beginning arteriolar
changes. When seen 6 weeks postpartum, the blood pressure was still 146 mm. mercury systolic
and 100 mm. mercury diastolic. There was a trace of albumin in the urine.
Question: What advice should be given this patient about subsequent preg-
nancies?
Discussion: It would appear that this is a case of hypertensive disease with early
vessel changes and a minimum of kidney involvement. With advancing years there
is usually a slow but definite worsening of the condition, and her life expectancy is
probably less than normal. There have been 2 pregnancies without any discernable
effect upon the disease either during pregnancy or later. On this basis one might be
inclined to say that in this case the hypertensive disease was not adversely affected
by pregnancy and that further pregnancies would cause no more damage. On the
other hand, several recent long range studies upon groups of such patients would
indicate that with continuing pregnancies, only half as many are alive after 10
years as compared to those in whom pregnancy did not occur. With this in mind,
it would probably be good preventive medicine to advise against future pregnancies.
Much work has been done looking toward a reduction in immediate maternal
mortality, and the results have been most gratifying, so much so that it would
appear that we have now arrived at a point where we might expand our efforts and
think of the long range effect of various conditions upon the life of the mother. A
condition in which pregnancy affects longevity as greatly as hypertensive, arteriolar
sclerotic disease appears to be affected certainly deserves serious consideration.
99
BOOK REVIEWS
Eyes and Industry. Eedwig S. Kuhn, M.D. 2nd Edition, C. V. Mosby Co., St. Louis, 1950. pp. 308
■with 151 illustrations. Price $8.50.
The problems of industrial ophthalmology, with their many ramifications, are becoming more
and more intricate and demand more attention as time goes on. The whole question is posed and
answered very adequately in this concise and useful volume. The relationship between ophthal-
mology and industry and the results consequent upon this relation are skillfully presented. A dual
result is produced: one is economic in nature, since maximal visual acuity of any given employee,
irrespective of his particular job, is essential if industrial efficiency and maximal output are to be
maintained. The second result is a program designed to correct as many visual hazards as pos-
sible and decrease to a minimum ocular injury, whatever the etiological factor may be.
Such a dual effect is brought about only after a tremendous effort is expended conjointly by
industrialists and ophthalmologists. The latter alone do not formulate the entire program but
act more in a consultative capacity.
The author shows the vital necessity of an industrial ophthalmologist in becoming not adequately,
but perfectly, acquainted with all the industrial methods and problems in any given plant. It is
essential that he have a working knowledge of all types of work in the plant, and what maximal
visual acuity is necessary for any given employee. Conversely, industrialists should be taught the
fundamentals of eye care, hazards and their prevention, protective measures, and above all, the
visual adaptability of any given employee for his particular job. Employees not meeting the visual
requirements for their jobs should be changed to other jobs with as much expediency as possible.
Constant emphasis is placed upon the importance of the eye consultant being a "visual engineer";
at the outset, he is to make a thorough tour of the plant, noting each branch of the plant, its meth-
ods, and the visual acuity of each employee at his job. Master charts are then made, along with a
thorough analysis of the visual program to be formulated. Protective devices, illumination, pos-
sible hazards, — are all noted. The author then proceeds to the way in which a visual progiam is
laid out.
The sections on eye corrective programs, methods of screening and testing of visual acuity of all
employees, are carefully written, and much time is expended in the construction of these chapters.
There is an excellent section on the medical and surgical care of industrial eye diseases, the read-
ing of which will prove very valuable not only to the industrial ophthalmologist, but to the general
practitioner of ophthalmology.
The entire book is clearly and concisely written, with more emphasis on some aspects of the
problem being given than on others, but achieving an over-all balance that intimates a full knowledge
of the subject on the author's part, as well as a broad personal experience with industrial eye dis-
eases.
John C. Ozazewski, M.D.
Physiology of the Eye, Clinical Application. Francis Heed Adler, M.A., M.D., F.A.C.S. Price
$12. Pp. 709, with 319 illustrations. St. Louis: C. V. Mosby Co., 1950.
The author has made a valuable contribution to all who are interested in the functioning of the
eye and in the visual process. Although, as the title indicates, clinical applications of the funda-
mental phenomena are made, the major emphasis is upon the relations between anatomic structure
and function. The book is elegantly illustrated in both the anatomic and physiologic aspects.
This reviewer is particularly impressed by the excellent treatment of the basic physiology of
circulation of the blood, the anatomy and physiology of muscle, the nervous centers and pathways
for voluntary movements and reflex activity, and electrical phenomena in nerves. From the funda-
mentals, Dr. Adler then proceeds to the development of the special and clinical aspects of each
function in its relation to vision.
Without slighting the modern theories, the author in most cases, has adopted a judicious and un-
biased treatment, emphasizing those concepts which have been most tested. This attitude is well
illustrated in his brief but coherent treatment of color vision.
100
BOOK REVIEWS 101
The range of the physiology of vision has become so broad that one is pleasantly surprised to
encounter a single volume text which covers this field so completely and clearly.
R. H. Osier, Ph.D.
Principles and Practice of Surgery. Jacob K. Berman, Associate Professor of Surgery, Indiana
University, School of Medicine; Associate Professor of Oral Surgery, Indiana University, School
of Dentistry. 1378 pages; C. V. Mosby Co., St. Louis, 1950. Price $15.00.
This newest textbook of surgery was written primarily to correlate the basic sciences and the
fundamental principles of surgery. The first four parts are devoted to the general concepts of the
reaction of the body to injury and includes many valuable charts and tables to supplement the
text. The chapters on the interchange of body fluids and acid-base balance are to be highly recom-
mended.
The fifth part is devoted to the diseases and injuries of specific organs and systems and constitutes
the major portion of the text. The author has emphasized the newer concepts of surgery and the
newer operative procedures sometimes at the expense of the older and more acceptable procedures
of surgery. The section on "Diseases of the Alimentary System" brings into one place the major
disorders of man's digestive tract; but at times, the more common afflictions of the intestinal tube
are described briefly while a rather rare but more interesting disease is described at length.
Following the modern trend, fractures are discussed very briefly, that the portions of this text
devoted to the healing of bone and to diseases of the bones are excellent.
This text book has in one volume condensed a vast amount of knowledge of pathologic physiology
and biochemistry pertaining to the surgical patient not collected in any one text book before. It
is an excellent text for the experienced surgeon.
E. Roderick Shipley, M.D.
Surgery of the Shoulder. .4. F. DePahna, James Edwards, Professor of Orthopedic Surgery and
Head of the Department, Jefferson Medical College, Philadelphia. 438 pages, illustrated. Phil-
adelphia: J. B. Lippincott Co., 1950. Price: $17.50.
This is an excellent source of information on pathologic conditions affecting the shoulder and
the more frequently seen entities responsible for shoulder dysfunction. The author introduces his
subject by chapters on the comparative and normal anatomy of the pectoral girdle. The abnor-
malities and diseases of the shoulder are then clearly and order!}' presented in nine chapters fol-
lowed by a discussion of the surgical approaches and procedures involved in this area.
This book is outstanding in its wealth of photographs and drawings which supplement the text.
The author has presented with the text and illustrations many studies on individuals who were
examined during life and at autopsy.
The shoulder is one of the rare medical texts that combines excellent organization and writing
with superb manufacture.
E. Roderick Shipley, M.D.
Pathologic Physiology: Mechanisms of Disease. Edited by William A. Sodeman, M.D.,
F.A.C.P. W. B. Saunders Co. Philadelphia 1950. pp. 808. price $11.50.
The purpose of this volume is to bridge the gap between physiology and clinical medicine, a
goal which it achieves in admirable fashion. Dr. Sodeman has gathered a group of 25 contributors
each of whom is a recognized authority in the field of endeavor which he covers. The book is by
no means intended as a substitute for the usual textbook of medicine since it does not deal in a
systematic manner with etiology, symptoms and treatment. On the other hand, it attempts, to dis-
cuss diseases of each organ system in terms of disturbed physiology. The modern teacher of clinical
medicine recognizes that this approach is the most successful one toward achieving a true under-
standing of disease entities. The material covered in each section is voluminous; the concepts pre-
sented are quite current. Probably because of spare limitations, the compression of complex data in
as short a space as possible produces a telegraphic style which must be reviewed several times to
become intelligible. Each section, however, is followed by a selected bibliography which permits
the interested reader to pursue the subject in greater detail. The book can be heartily recommended
as supplementary reading for the senior medical student, the house officer, and the practicing phy-
sician. The publishers, as usual, have prepared an extremely attractive format.
Milton S. Sacks, M.D.
MEDICAL SCHOOL SECTION
MEDICAL LIBRARY NOTES
In the period from November 1, 1950 to February 1, 1951, the following indi-
viduals made gifts of books and journals to the library:
Mr. Leonard Flax Dr. H. S. Rubinstein
Dr. Arthur M. Kraut Dr. Frank W. Hachtel
Dr. Maurice C. Pincoffs Dr. A. F. Thompson, Jr.
Dr. John E. Savage Dr. Margaret Ballard
Dr. H. Boyd Wylie Dr. Donald E. Fisher
One alumnus has made an excellent suggestion and a generous offer. He knows
that additional copies of much used texts are always needed in the library to meet
students' demands. Hence, he has asked for a list of texts needed in duplicate, so
that he may furnish some of the additional copies as a gift. This is a fine and practical
offer which will be appreciated by both students and library staff.
The library has been fortunate in procuring a copy of the medical dissertation of
John Beale Davidge, 1768-1829, important figure in the early history of the School
of Medicine and University of Maryland. This thesis is dedicated to Drs. James and
William Murray of Annapolis, with whom Davidge began the study of medicine
before going to Edinburgh to continue his education. In accordance with the classical
tradition, the work is written in Latin and bears the following title-page:
Dissertation physiologica,
de
Causis Catameniorum.
Auctore
Joanne Beale Davidge, M.A.M.D.
B irminghamiae,
Ex Officina T. Pearson.
MDCCXCTV
In February, 1951, the Maryland Historical Society borrowed the Medical Li-
brary's portrait of Dr. Nathaniel Potter by St. Memin to be included in an exhibit
of St. Memin's work. The display of this eminent artist's productions continued
for about two months. The portrait, owned by the Medical Library, is well known,
having been photographed years ago by the Frick Museum in New York for display
there.
DRS. CATTELL AND CLUXTON TO HEAD LUTHERAN HOSPITAL
SYMPOSIUM
Dr. Richard Cattell of the Lahey Clinic, speaking on the subject of "Thyroid
Surgery", will head the program of the annual Medical and Surgical Symposium
to be held at the Lutheran Hospital on May 5, 1951, under the auspices of the
BULLETIN OF THE SCHOOL OF MEDICIXE, U. OF MD.
Medical Association of the Lutheran Hospital of Maryland. Dr. Harley Cluxton,
head of the Research Division, Armour and Company, will speak on "Recent De-
velopments in the Clinical Application of ACTH".
While the program is as yet incomplete, other distinguished speakers include
Dr. Richard P. Custer, Pathologist at the Presbyterian Hospital, Philadelphia.
Dr. Custer will speak on "Certain Aspects of Leukemia and Hodgkin's Disease".
The organization of this annual Symposium is under the direction of Dr. Pierson
M. Checket. All interested physicians are cordially invited. Details of the program
may be secured through the Administrative Office of the Lutheran Hospital.
PROGRESS NOTE II
View of extent of construction of the new Psychiatric Building as of February 1, 1951
DEPARTMENT OF PHYSIOLOGY
Dr. William R. Amberson has recently received a grant of $6973.56 from the LT. S.
Public Health Seivice to continue his studies on the physico-chemical architecture
of muscle cells.
Dr. John I. White has been appointed Research Fellow in Physiology.
Dr. William Amberson, Professor of Physiology and Miss Sylvia Himmelfarb
attended the 18th International Physiological Congress in Copenhagen in August,
1950. Dr. Amberson presented to the Congress a paper entitled "Complex Forma-
tion in Protein Solutions Obtained by Mild Extraction of Skeletal Muscle". After
the Congress, Dr. Amberson visited various English and continental universities,
lecturing on his research work concerning muscle proteins.
During the summer, Dr. D. C. Smith continued his study of the fish thyroid at
the Lerner Marine Laboratory, Bimini, Bahamas.
Dr. D. C. Smith, Di. Frederick Ferguson, and Dr. J. Mc. Turner gave a series
of lectures in the fall of 1950, at the Fort Howard Veterans Hospital on the physiology
of digestion, circulation, and the kidney.
Dr. D. C. Smith has received a grant of $450 from the American Philosophical
Society to support his work on the physiology of the fish thyroid.
MEDICAL SCHOOL SECTION iii
MERCY HOSPITAL
The Dental Department of Mercy Hospital has recently been approved by the
American Dental Association for Resident training in Dentistry.
Sister M. Veronica, Superintendent of Mercy Hospital, attended the Annual
Meeting of the Executive and Administrative Boards of the Catholic Hospital
Association, on January 13-15, 1951, at Marillac Social Center, Chicago, Illinois.
Dr. Charles E. Brambel, Chief of the Biochemistry Department at Mercy Hospital,
was elected Chairman of the Maryland Section of the American Chemical Society
for 1951. Dr. Brambel attended the Josiah Macy Junior Foundation Conference on
Blood Clotting and Allied Problems, on January 22 and 23, at the Beekman Hotel,
New York City. This is the fourth conference Dr. Brambel has attended.
Dr. Allyn F. Judd, Assistant Resident Physician at Mercy Hospital, left the
hospital November 21, 1950, for service at Tinker Air Force Base, Oklahoma City,
Oklahoma.
Dr. John A. Spittel, Jr., Assistant Resident Physician at Mercy Hospital, left
the hospital November 4, 1950, for service at Sheppard Army Air Force Base,
Wichita Falls, Texas.
Dr. Frank J. Theuerkauf, Jr., Junior Assistant Resident Surgeon at Mercy Hospital
reported February 3, 1951, to Fort Sam Houston, Texas to serve in the U. S. Army.
Dr. A. Maynard Bacon, Pediatrician on the Mercy Hospital Visiting Staff, re-
ported February 14, 1951 to Boiling Field, Washington, D. C. for service in the
Army Air Force, as Captain.
Recently Appointed Hospital Visiting Staff Members:
Dr. Frank J. Ayd, Jr. Dr. Edward L. Suarez-Murias '
Dr. Harold P. Biehl Dr. John F. Ullsperger
Dr. Arthur L. Davenport Dr. Lawrence R. Wharton
Dr. Anthony F. DiPaula Dr. Samuel F. Wolf
Dr. Burton V. Lock Dr. John D. Young, Jr.
Dr. Walter K. Spelsberg
Recently Appointed Mercy Hospital Resident Staff — July 1, 1951, to June 30, 1952.
(incomplete list)
Surgery:
Karl A. Dillinger, M.D Resident in Surgery
Clyde D. Thomas, M.D Associate Resident in Surgery
Margaret L. Sherrard, M.D Senior Assistant Resident Surgeon
Leonard G. Hamberry, M.D Junior Assistant Resident Surgeon
William B, Rever, M.D Junior Assistant Resident Surgeon
Sim Penton, M.D Resident in Thoracic Surgery*
Pomeroy Nichols, Jr., M.D Junior Resident in Neurosurgery
(July 1, 1951 to January 31, 1952)
George W. Smith, M.D Senior Resident in Neurosurgery
(February 1, 1952 through June 30, 1952)
* Resident at Mercy, City and University Hospitals. Consult Dr. Brantigan regarding appoint-
ment date.
iv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Medicine:
Howard F. Raskin, M.D Senior Assistant Resident in Medicine
Charles R. Ireland, M.D Assistant Medical Resident
Frank T. Kasik, Jr., M.D Assistant Medical Resident
Paul F. Richardson, M.D Assistant Medical Resident
Gynecology and Obstetrics:
John A. Ferris, M.D Resident in Gynecology
Arthur R. Fleming, M.D Resident in Obstetrics
DEPARTMENT OF PEDIATRICS
The Pediatric Department has shared with the Department of Gynecology
$5,000 from the Bressler Research Fund for several research problems relating to
endocrinology.
Current research problems include:
1. The effect of B-12 on growth and development of normal infants.
2. The effect of B-12 on the growth and development of premature infants and
its effect on the hemogram.
3. Identification of carcinoma of the gastrointestinal tract by cytological diagnosis.
4. The comparison of fetal and maternal diphtheria antitoxin levels.
5. Continued work on lead poisoning with particular emphasis on the significance
of coprophryin iii excretion.
The Cardiac Clinic in the Pediatric Department has been approved by the Amer-
ican Heart Association. The Cardiac Clinic is under the direction of Dr. Sidney
Scherlis with Dr. Gibson Wells as Associate Director, and working in the Clinic
at regular intervals is Dr. Mary Hayleck.
DEPARTMENT OF ROENTGENOLOGY
Dr. Robert E. Cato, Resident in Roentgenology, was called to active duty October
6, 1950 by the Navy Department, and is now on duty at the U. S. Naval Hospital,
Philadelphia, Pennsylvania.
Dr. James F. Dougherty, Jr., Assistant Resident in Roentgenology, was called
to active duty with the U. S. Navy October 21, 1950 and is now stationed at the
U. S. Army Hospital, Camp Cooke, California.
Dr. John Brackin, Jr., Director of the Department of Roentgenology in the U. S.
Veterans Hospital, Fort Howard, Maryland, has recently been appointed to the
faculty of the School of Medicine as Instructor in Roentgenology.
Dr. Joseph C. Furnari, class of 1942, has been appointed Fellow in Roentgenology.
EASTERN CONFERENCE OF RADIOLOGISTS
The Eastern Conference of Radiologists met at the Lord Baltimore Hotel on
March 8th, 9th and 10th. The following papers were given by members of the faculty
of the School of Medicine.
"Pelvimetry as Related to the Mid Planes", Dr. D. Frank Kaltreider
"Discussion of Unusual Thoracic Surgical Patients", Dr. Otto C. Brantigan
"Tuberculous Peritonitis", Dr. John Brackin, Jr.
MEDICAL SCHOOL SECTION v
"The Radiologist's Role in Bronchography", Dr. Charles Davidson
"Lipomatous Hypertrophy of the Ileo-cecal Valve", Dr. Monte Edwards
"Various Non-Vascular Lesions Seen Through or Simulating the Cardio- Vascular Silhouette on
the P. A. Chest Film", Dr. Edward R. Dana
"Environmental Radiation and Cancer", Dr. Frank H. J. Figge
"The Roentgen Manifestations of Tuberous Sclerosis", Dr. John De Carlo, Jr.
"Antibiotic Therapy of Certain Acute Pulmonary Lesions with Discussion of Their Non-Specific
Roentgen Appearance", Dr. Theodore E. Woodward
"Influence of Certain Gynecological Disorders on the Urinary Tract", Dr. J. Mason Hundley, Jr.
Mr. Tucker Retires
After completing thirty years of service Mr. John Tucker, Purchasing Agent,
retired on February 1, 1951.
FACULTY NOTES
Dr. Robert E. Bauer, Instructor in Medicine, has begun organization of a long
term project dealing with the behavior of body fluids and effusions, the study being
conducted through the medium of radioactive phosphorous and iodine. The pro-
gram is under the sponsorship of the Atomic Energy Committee through a grant
in aid.
Dr. Eduard Uhlenhuth, Professor of Anatomy, was a recent guest speaker at the
Urological Post Graduate Seminar sponsored by the American Urological Associa-
tion held at the University of Texas, Dallas Texas from January 29th to February
2nd, 1951. Dr. Uhlenhuth spoke on "The Anatomy of the Genito Urinary System
and Congenital Anomalies of the Genito Urinary System."
Dr. Jacob E. Finesinger, Professor of Psychiatry, was recently guest speaker at
a seminar of personnel attached to the Army Chemical Corps Medical Division at
Edgewood, Maryland. Dr. Finesinger spoke on "Talking to People". Dr. Fine-
singer is principal investigator for the Chemical Corps on the psychiatric and psycho-
logic aspect of chemical warfare.
Dr. Otto Charles Glaser, Professor Emeritus of Zoology at Amherst College'
died at Northhampton, Massachusetts, on February 8, 1951. Dr. Glaser will be
remembered by alumni of the College of Physicians and Surgeons where he was a
member of the Faculty about 1905.
NEW CLASSIFICATION OF CERVICAL CARCINOMA
As the result of a long study by numerous professional committees, the following
standard Classification of Carcinoma of the Cervix was adopted on the occasion of
the International and Fourth Congress on Obstetrics and Gynecology, the classi-
fication superseding that of the health Organization of the League of Nations in
1937.
The Classification is published herewith for your information.
Stage 0
Carcinoma in situ — also known as preinvasive carcinoma, intraepithelial carci-
noma, and similar conditions.
vi BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Stage I
The carcinoma is strictly confined to the cervix.
Stage II
The carcinoma extends beyond the cervix but has not reached the pelvic wall.
The carcinoma involves the vagina but not the lower third.
Stage III
The carcinoma has reached the pelvic wall. (On rectal examination no ''cancer-
free" space is found between the tumor and the pelvic wall.)
The carcinoma involves the lower third of the vagina.
Stage IV
The carcinoma involves the bladder or the rectum, or both, or has extended
beyond the limits previously described.
Charles anb #eorge
To the many medical students, visitors, attending physicians and House Staff
who have passed through the University Hospital during the past thirty years,
Charles and George, the two uniformed porters, became almost legendary figures
through their exemplification of gentle courtesy, willingness and politeness. Always
ready to offer a cheerful greeting, their long tenure and the friendly spirit they
created placed them well at the top of the hospital family.
Charles Newman became associated with the University Hospital in 1911 and
George Fossett in 1924.
On December 4, 1950, George was admitted to the Accident Room in coma, dying
shortly therafter of a cerebral hemorrhage. Charles was admitted to the Hospital
the same morning with acute heart failure, dying on December 21st.
Two familiar and loyal figures for over a quarter century have thus passed. They
will be missed by their many friends among the staffs of the University and the
hospital.
May 21 Monday
May 28 Monday
May 30 Wednesday
June 2 Saturday
June 7 Thursday
June 8 Friday
June 9 Saturday
Academic Calendar, 1951
Junior examinations begin
Junior examinations continue
Sophomore and Freshman examinations begin
Holiday — Memorial Day
Announcement of graduates
Alumni Day
Pre-commencement exercises
Commencement
POST-GRADUATE COMMITTEE SECTION
POST GRADUATE COMMITTEE, SCHOOL OF MEDICTNE
Howard M. Bubert, M.D., Chairman and Director
Elizabeth Carroll, Executive Secretary
Post Graduate Office: Room 600
29 South Greene Street
Baltimore 1, Maryland
DO WE NEED TO TRAIN MORE PHYSICIANS?
PAGE C. JETT, M.D., Chairman
Committee on Rural Medicine
Medical and Chirurgical Faculty of Maryland
Doctors seem to be the only people who are not convinced that we need to train
more physicians. Most students of medical care have felt that the most vulnerable
point in the present system of medicine is the failure of the medical profession to
anticipate and fill the ever-increasing demand for physicians. Dr. Lowell Reed of
Baltimore, Chairman of the Surgeon-General's Committee for Medical Education,
states, ''Out of this experience, I believe that we need a sizable increase in the number
of doctors in order to carry on medicine in the framework of private enterprise
which we hope to maintain."
Physicians have argued^ that their income structure and limited hospital facilities
will not support any more physicians, that the problem is only one of distribution
from urban to rural communities and, further, that the efficiency of doctors has been
multiplied by advances in medicine, transportation, and hospital services.
This conclusion would seem to be refuted by the fact that the 79 medical schools
in this country are training the same number of physicians they did in 1905 despite
the tremendous growth in population, the increased demands of the armed services,
the U. S. Public Health Service, the Veterans Administration, and research. In
addition, a higher percentage of physicians are entering specialties, thus further
reducing the ranks of the general practitioner to such an extent that there is scarcely
a community in the United States which is not asking for more. Thus, the problem
becomes one of supplying this need; however, this is rendered more difficult by the
difference in the fees of the general practitioner and the specialist, a subject which
will not be discussed here.
It is felt that a better qualified general practitioner can be produced if we follow
this plan. First, every medical school would realize an obligation to the surrounding
community, hospitals, and physicians, and organize within its geographical and
traffic area, a center with a regional hospital plan, embracing all rural hospitals within
such an area. The relationship between the medical school and the area would be a
benevolent type of advisory service supplying postgraduate education, rotating
interns through rural hospitals, and, in unusual cases, serving to take the responsi-
bility from the general practitioner and at the same time using these cases for teaching
purposes in the center.
via BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID.
The general practitioner today receives one year of intern training. For this
reason, one of the great deterrents to men entering rural general practice is the
fear of having to meet serious medical emergencies without aid of consultation.
Secondly, it is suggested that the medical schools set up a two-year residency in
general practice so that the name of the general practitioner might be dignified
by adequate training and so that hospital affiliation with the "center" institution,
the first year to be spent in a general rotating internship and the second year to be
divided between a regional hospital and the '"center's" out-patient department.
When the deans t)f the medical schools were approached as to the means of in-
creasing the number of doctors, they stated that a 15 per cent increase in physicians
is being planned at the present time. This would supply 750 doctors. Their feeling
was that they could not expand without materially impairing the quality of the
graduate. Further, they felt that there are certain areas of the United States which
are without a medical school, and with the increasing state medical licensure bar-
riers that are being erected, each state, in all probability, would be forced to have
its own medical school. The cost of increasing the number of medical students to
an adequate figure has been estimated at approximately forty million dollars a
year. There is no source at this time with the exception of tax-supplied funds, which
could possibly meet this need; and the present Congressional bill for Federal support
of medical education, with its provision for creating a professional advisory council,
would be a safeguard from political interference in the management of our medical
schools.
In reviewing the Hippocratic Oath, the following is pertinent: "To reckon him who
taught me this art equally dear to me as my parents; to share my substance with him and
relieve his necessities if required; to look upon his offspring in the same footing as my
own brothers, and to teach them this art, if they shall wish to learn it, without fee or
stipulation . . . ."
Therefore, it is suggested that each physician, as he comes to his twentieth an-
niversary, make a pledge to his alma mater of at least one thousand dollars to be
paid over a five-year period. In doing this, he would be fulfilling his Hippocratic
obligation and accomplishing something to solve the needs of current medical educa-
tion. Thereby he shows that he is cognizant of the problem and means to do some-
thing about it.
INDUSTRIAL MEDICINE
The November 14, 1950 meeting of the current series of Post Graduate Lectures
given in Hagerstown, Md., was devoted to industrial medicine. Dr. Robert Cheno-
with presented a paper on "The Role of the Physician in Industrial Accidents,"
and Dr. Nathan B. Herman spoke on "A Survey of the Occupational Disease Situa-
tion in Maryland." Both Drs. Chenowith and Herman are members of the Committee
of Industrial Medicine of the Medical and Chirurgical Faculty and have been co-
operating with the Post Graduate Committee in this venture. The meeting was well
attended, and those present evidenced a great deal of interest in the subject matter
presented. The possibility that similar presentations might be repeated during
later extramural sessions would seem worthy of serious consideration. Most of
the physicians in the State are familiar with the compensation law as it applies to
POST GRADUATE COMMITTEE SECTION
industrial accidents, in view of the fact that it has been in force for some 35 years.
However, occupational diseases have been compensable only since 1939, and it
would seem desirable for the profession at large to familiarize themselves with this
provision. Further, they should consider the possibility that diseases under treat-
ment might be occupational in nature.
The Post Graduate Committee wishes to express its appreciation to Drs. Cheno-
with and Herman and to express to this Committee of the Medical and Chirurgical
Faculty its desire to cooperate in every possible way in disseminating information
about this important subject.
MARYLAND ACADEMY OF GENERAL PRACTICE
A varied and interesting program, arranged with the Post Graduate Committee
by Dr. Lauriston L. Keown, was presented to the Maryland Academy of General
Practice at the University Hospital on December 7, 1950. The Committee was
delighted with the size of the attendance, the large area represented, and the interest
displayed.
Officers of the Academy are: Dr. Charles F. O'Donnell, President; Dr. Irving
Baumgartner, Secretary -Treasurer; and Drs. Paul Knotts, Nathan Needle, and
B. B. Kneisley, Vice-Presidents. The Committee shares their hope that similar
programs may be repeated many times in the future.
CHOOL AND HOSPITAL PLATES
Plates of the School of Medicine, University of Maryland,
3 New Hospital, and the Old Hospital are available. These
lite plates are 10 inches in diameter with black print. The
ice is $2.50 each, plus 25 cents insurance and postage. Send
ier, stating the plates desired, with check to Mrs. Bessie M.
nurius, Box 123, University Hospital, Baltimore, Maryland,
ike check payable to Nurses Alumnae Association of the
diversity of Maryland.
Murray-Baumgartner
SURGICAL INSTRUMENT
COMPANY, INC.
EQUIPMENT AND SUPPLIES
FOR THE
HOSPITAL - DOCTOR - PATIENT
RENTALS
BEDS - LAMPS - WHEEL CHAIRS
5 WEST CHASE STREET
BALTIMORE 1, MD.
SAratoga 7333
ALUMNI ASSOCIATION SECTION
OFFICERS
Louis A. M. Krause, M.D., President
Vice-Presidents
Samuel E. Enfield, M.D. Randolph M. Nock. M.D.
Thurston R. Adams, M.D., Secretary Simon B
Minette E. Scott, Executive Secretary Charles
Board of Directors Hospital Council
William H. Triplett, M.D. Alfred T. Gundry, M.D.
Chairman George F. Sargent, M.D.
Louis A. M. Krause, M.D.
Charles Re id Edwards, M.D.
Thurston R. Adams, M.D.
Simon Brager, M.D.
Austin Wood, M D.
Wethf.rbee Fort, M.D.
Albert E. Goldstein, M.D.
Daniel J. Pessagno, M.D.
Louis H. Douglass, M.D.
Nominating Committee
Frank Ogden, M.D.
Chairman
Robert F. Healy, M.D.
Ernest I. Cornbrooks, M.D.
Frank K. Morris, M.D.
David Tenner, M.D.
Alumni Council
Fred B. Smith, M.D.
rager, M.D., Assistant Secretary
Reid Edwards, M.D., Treasurer
Library Committee
Milton S. Sacks, M.D.
Representatiics to General Alumni
Board
John A. Wagner, M.D.
Thurston R. Adams, M.D.
William H. Triplett, M.D.
Representatives, Editorial Board,
Bulletin
Harry C. Hull, M.D.
Albert E. Goldstein, M.D.
Louis A. M. Krause, M.D.
(ex-officio)
Lewis P. Gundry, M.D.
The names listed above are officers for the term beginning July 1, 1950 and ending June 30, 1951.
AMERICAN MEDICAL ASSOCIATION MEDICAL
EDUCATION FOUNDATION
In December, 1950, the Board of Trustees of the American Medical Association
created the American Medical Education Foundation, the purpose of which is to
support medical education through distribution of voluntary contributions to schools
of medicine on an unrestricted basis.
The announcement of this important step was carried in a two page article in the
February 17, 1951 Journal.1 Since that date a revision of policy concerning con-
tributions has been made.2 As a further stimulus towards voluntary contributions
from physicians, the Board of Directors of the Medical Education Foundation
voted that individual physicians might designate the school or schools to which
their contributions might go. All funds thus collected will be promptly acknowledged
and will be assigned as of July 1, 1951 to the schools so designated.
The creation of the American Medical Education Foundation offers organized
medicine another challenge to governmental dictation for control of medical educa-
tion. Furthermore, through a non-profit central organization it affords a physician
an opportunity to contribute to the financial assistance of his Alma Mater or other
schools with the knowledge that if specified, the entire contribution will revert to
the recipient of his choice.
Alumni of the School of Medicine will find in the American Medical Education
Foundation another progressive and realistic move toward the defeat of the forces
1 J. A.M. A., 145: 46, (Organization Section).
2 J.A.M.A., 145: 648, (March 3, 1951).
ALUMNI ASSOCIATION SECTION xi
which would, through the use of public funds, seek to ultimately change current
concepts of medical education.
This Foundation has the wholehearted support of the Faculty of the School of
Medicine and you are urged to participate in it. You may feel certain that your
contribution will be used wisely and that every dollar will serve a most useful purpose.
In order that your contribution may be received by the School of Medicine in time
for inclusion in the 1951-52 budget, contributors should send their contribution to
Dr. Donald G. Anderson, Secretary-Treasurer of the Foundation, 535 N. Dearborn
Street, Chicago 10, Illinois, certainly before June 1, 1951.
PRESIDENT'S LETTER
The Alumni of our Medical School, now living, number about six thousand, prac-
tically all of whom are actively engaged in the practice of medicine. Their loca-
tions are as widespread as the geography of our country. However, the greater
majority of them are along the Atlantic seaboard. This being the case, it seems to
me they are in a position to make a helpful contribution to medicine in general and
to our University in particular. I have the temerity to offer a suggestion in the
name of our Alumni Association and am hopeful it will be fully considered by all
to whose attention it may come.
It cannot be that there are any among the group of six thousand who are not
familiar with the shortage of nursing personnel, a condition which is widespread
throughout the entire country. It must be equally well known that this condition
is seriously hampering medical progress, damaging the good name of medicine,
and denying to doctor and patient alike a service for which there is no substitute.
With the preparedness program of our government now in process of development,
we must expect to further deplete our roster of trained nurses by dividing generously
with the various armed services. Who will doubt that the services will determine a
required minimal quota of nurses and take steps necessary to get them? The method
by which medical officer personnel was recently procured should satisfy everyone
that necessity knows no bounds. The prospect is not bright for even the minimum
number of available nurses needed to keep our hospitals open and operating after
the service requirements have been satisfied. This is indeed a gloomy outlook, but
we should take it in stride and immediately set about doing something to remedy
it. Here is where I come forward with the previously mentioned suggestion.
Every alumnus should be able to influence at least one qualified young woman
of his acquaintance to embrace nursing as a profession and her life's work. A fine
School of Nursing is among those professional schools that make up our great Uni-
versity and one of which we have just reason to be proud. The excellence of its
curriculum, the quality of its staff, the scope of its training, and the high standing
of its graduates shine out as a beacon light to prospective students when its merits
are forcefully brought to their attention. Each of our six thousand alumni should
so completely familiarize himself with what this school has to offer that he would
be ready and willing to explain its advantages so convincingly that applications
for admission would far exceed the capacity not only of our school but also that
xii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
of our affiliated teaching institutions. If a campaign could be agreed upon and
actually launched and each of our alumni be imbued with sufficient interest to try
and recruit just one qualified applicant, I am satisfied the result would be not only
astounding but also a notable contribution to the furtherance of good, practical
medicine. To attempt to carry on in medicine without the aid of adequate nursing
is unthinkable, but unless we loyally help develop in young women of our acquaint-
ance a deeper interest in entering the profession, we have no other prospect. I,
therefore, in the name of the Medical Alumni Association offer a plan and throw
out a challenge feeling that the urgency is great, the cause worthy, and the reward
promising.
''There are thousands to tell you it cannot be done,
There are thousands to prophesy failure;
There are thousands to point out to you, one by one,
The dangers that wait to assail you.
But just buckle in with a bit of a grin,
Just take off your coat and go to it;
Just start to sing as you tackle the thing
That "cannot be done", and you'll do it".*
William H. Triplett, Chairman
Board of Directors
ALUMNI DAY PROGRAM, 1951
Annual Alumni Day Exercises on June 7th promise to be even more interesting
and attractive than the successful meeting of 1950. The Alumni Association this
year pays honor to the members of the class of 1901 who will receive at the annual
banquet their life membership in the Alumni Association and the 50-year certifi-
cates from Dr. Louis A. M. Krause, President of the Alumni Association.
Activities will begin at 9 A.M. with registration in the Alumni Office and in the
rotunda of the University Hospital. From 10 A.M. until 12 noon, a Scientific Session
has been planned which will include papers on current researches at the School of
Medicine with Clinical Pathologic Conferences to be discussed by Drs. Pincoffs
and Spencer.
At 12:30 P.M., a complimentary luncheon will be served in the Gordon Wilson
Amphitheater in the University Hospital, this to be followed at 2 P.M. by the an-
nual business meeting of the Medical Alumni Association.
The Alumni Honor Award for 1951 will be presented to Dr. George E. Bennett
of the class of 1909. Dr. Bennett's address, which should be of great interest to
those alumni who attended the School of Medicine during the years from 1905 to
1910, is entitled "Reminiscences of the Class and Faculty of 1909". The "reunion
classes" will no doubt hold their individual reunions from 5 to 7 P.M.
The annual banquet this year will be held at the Lord Baltimore Hotel. The
high spot of the program will be the presentation of the fifty year certificates to the
class of 1901. Details of the program will be mailed to each alumnus.
* "It Couldn't Be Done" is from the book The Path to Home by Edgar A. Guest; copyright
1919 by The Reilly & Lee Co., Chicago.
ALUMNI ASSOCIATION SECTION xiii
Printed herewith is a reservation form for hotel accommodations which should
be secured in advance through the Alumni Office.
RESERVATION FORM
Secretary of the Medical Alumni Association
I will/will not be present for the Commencement Activities beginning June
7, 1951.
Kindly reserve a room at the Lord Baltimore Hotel single double
Date and time of arrival
Name Class
Address
CLASS OF 1941 PLANS 10TH REUNION
Plans are now underway for a reunion of the class of 1941. The Chairman of the
Committee for Organization is Dr. Pierson M. Checket, 1801 Eutaw Place, Baltimore
17, Maryland. All members of the class of 1941 are urged to contact Dr. Checket
for reservations and details of the class reunion which will be held on June 7, 1951.
RECEIVES "UNSUNG HERO AWARD"
Dr. Theodore E. Woodward, class of 1938, Associate Professor of Medicine,
was recently the recipient of the McCormick and Company (Baltimore) "Unsung
Hero Award".
This citation established in 1940 was originally designed to call public attention
to and to reward members of local scholastic football and lacrosse teams who had
contributed wholeheartedly and diligently to the success of their team, but who
had missed the headlines, thus remaining the unsung heroes of the team.
In 1948 the award was broadened to include a prominent citizen of Baltimore,
who, although not foremost in the public press, nevertheless contributed much
toward his community.
Previous recipients of this award have been George Sauer, Coach of the Naval
Academy football team and Arthur R. Watson, Director of the Baltimore Zoo.
In the presentation ceremony which took place on December 8, 1950, Dr. Wood-
ward was awarded a silver tray in recognition for his extensive investigation of
infectious diseases. The inscription on the tray reads as follows:
"To Dr. Theodore E. Woodward
The McCormick Company Unsung Hero Award for his personal risks and sacri-
fices in the field of research medicine which have produced immeasurable contribu-
tions to the welfare of mankind.
December 8, 1950
Baltimore, Maryland"
xiv BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD.
TO RECEIVE ALUMNI HONOR AWARD
Dr. George E. Bennett, internationally known orthopedic surgeon and Adjunct
Professor of Surgery Emeritus of the Johns Hopkins University School of Medicine,
and a member of the University of Maryland School of Medicine, class of 1909, will
be honored at the Alumni Day Activities on June 7th. Dr. Bennett will be presented
DR. GEORGE E. BENNETT, class of 1909
Photograph by Fabian Bachrach
with a gold key and a certificate for "outstanding contribution to medicine and
distinguished service to mankind."
Dr. Bennett was born in Claryville, New York, on April 15, 1885. During his
senior year in medical school, he served as intern at the University Hospital and
following his graduation served as house surgeon at the Hospital for the Ruptured
and Crippled in New York City. In 1914 he joined the faculty of the Johns Hopkins
University School of Medicine and rose to the rank of Adjunct Professor of Surgery,
which post he held from 1942 until his retirement in 1947.
ALUMNI ASSOCIATION SECTION xv
An internationally known authority on problems in orthopedic surgery, an emi-
nent clinician and a noted contributor to the advancement of his specialty, his
nomination for this high alumni honor climaxes a career which not only distinguishes
the man but which adds dignity and prestige to the institution wherein he began
his career.
APPOINTED MEDICAL DIRECTOR
Dr. Thomas S. Sexton, class of 1939, was recently appointed Medical Director of
the Massachusetts Mutual Life Insurance Company of Springfield, Massa-
chusetts.
DR. THOMAS S. SEXTON
Associate Medical Director
Massachusetts Mutual Life Insurance Co.
After graduating in Medicine, Dr. Sexton served as rotating intern at Mercy
Hospital, Baltimore. He then entered the United States Army Medical Corps
during World War II and served for four years.
Following his separation from the Army, he was appointed Fellow in Medicine
at the Mayo Clinic after which he joined the Medical Staff of the Massachusetts
Mutual Life Insurance Company in 1947.
FRATERNAL NEWS SECTION
ALPHA OMEGA ALPHA
The semi-annual dinner of the Beta chapter, Alpha Omega Alpha
Honor Medical Society was held on December 8, 1950. Following the
dinner, initiation ceremonies were held for five new members from the
class of 1951. Dr. H. Boyd Wylie, Dean of the School of Medicine
spoke on "Problems of Medical Education".
The following were the new initiates from the class of 1951.
Earl M. Beardsley Frank R. Perilla
Nancy Blades Henry G. Reeves, Jr.
Leo H. Ley, Jr.
The initiation was followed by a business meeting. A policy for the election of
alumni members was discussed and a recommendation was made to the school re-
garding research by students.
PHI BETA PI
On November 19, 1950, the Alumni Association of Phi Beta
Pi Fraternity, Zeta Chapter, elected Dr. Frank C. Marino to
the office of president. Dr. Marino succeeds Dr. W. C. Duffy,
who was the key figure in the reactivation of Zeta in 1947.
The active members of Zeta administered the initiation rite
to 27 pledges on the evening of February 10, 1951.
A series of medical lectures has been planned for the coming
year. Dr. Emil Novak will deliver the first lecture on the topic
of ovarian tumors. Dates for these lectures will be announced
at a later time.
PHI DELTA EPSILON
Guest speakers at the monthly scientific meetings of
Phi Delta Epsilon recently included Drs. Louis A. M.
Krause, Lewis Hill, Harold Himwich and Philip Bard.
These scientific forums have been well attended by the
student body and faculty of the School of Medicine.
Future guest speakers will include Dr. Helen Taussig.
Dr. Louis V. Blum, class of 1934, was recently elected
President of the Graduate Club of Phi Delta Epsilon.
Dr. George Greenstein, class of 1950, has been ap-
pointed House Surgeon at the New York Hospital for
Joint Diseases.
Dr. Arnold Traymer, class of 1949, has been appointed Assistant Resident in
Pediatrics at Baltimore City Hospitals beginning in July, 1951.
Dr. Wallace Sadowsky, class of 1942, is now serving as Assistant Resident in
Surgery at Perry Point Veterans' Hospital, Perry Point, Maryland.
Dr. Shipley Glick, class of 1925, Assistant Professor of Pediatrics at the School of
Medicine, has recently been elected National Grand Vice Counsel of Phi Delta Epsilon.
OF
THE SCHOOL OF MEDICINE
UNIVERSITY OF MARYLAND
VOLUME 36 July, 1951 NUMBER 3
THE DIAGNOSIS AND TREATMENT OF THE ACUTE ABDOMEN
L. KRAEER FERGUSON, M.D.*f
The acute emergencies of the abdomen are the most frequent and interesting of the
lesions with which the practicioner has to deal. His primary duty is the recognition of
the condition as an emergency, because most emergencies can be handled easily and
successfully if treated early. They may lead to serious if not fatal results if delay or
procrastination is practiced. In acute abdominal disease, the doctor is often called for
the first time at night, after a day spent in trial of home remedies, enemas, etc. It is
inconvenient to the doctor, but lifesaving to the patient if he is seen promptly and
not allowed to "ride over 'till morning". The practice of simply relieving pain by an
injection of morphine and perhaps also one of penicillin, without a thorough enough
examination to arrive at a diagnosis, may permit a simple appendicitis to go on to
perforation or a strangulated intestine to progress to gangrene. The acute abdomen
cannot be put off lightly.
There are certain symptoms which indicate the probability of serious intra-ab-
dominal trouble. Abdominal pain lasting six hours or more, especially if the patient
was previously well, usually indicates some definite abdominal difficulty. If this is
associated with nausea and vomiting, elevation of pulse and decreased peristalsis,
there is good reason to believe that the difficulty may need surgical intervention, and
hospitalization is advised.
It is important to make a diagnosis, if possible, in every case of acute abdomen.
This is sometimes difficult if not impossible in many cases because the symptoms of
many conditions are very similar and the findings on examination may also be much
alike. In such cases the diagnosis may be less important than the recognition that
there is an acute abdominal lesion present that requires surgical treatment. Ogilvie,
in his characteristic fashion, expresses the surgical viewpoint thusly: "Surgery,
broadly defined, is a method of treatment by manual processes. Surgery does not,
like medicine, look upon diagnosis as the chief expression of its art, but rather as a
means to an end. A correct decision concerning the cause and pathology of a symptom-
* Professor of Surgery, Woman's Medical College of Pennsylvania and Graduate School of Medi-
cine, University of Pennsylvania, Philadelphia, Pennsylvania.
f Read before the Baltimore City Medical Society Joint Meeting with The Section on Surgery,
March 16, 1951.
Received for Publication April 20, 1951
103
104 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID.
complex is of great importance but only insofar as it points the way to correct treat-
ment. A decision is more important than correctness because, very often in surgery,
treatment must be immediate to be effective; and that ultimate solvent, the lapse of
time, is apt to lead to the final court of pathological exactitude — the post-mortem
room". I do not mean to convey the idea that any means should be ignored to arrive
at the definitive diagnosis in acute abdominal disease, but I do want to point out that
frequently a definitive diagnosis in acute abdominal disease can be made only by
surgical intervention, and the important thing is to recognize this position early.
The basis of diagnosis in the acute abdomen is a careful history and a thorough and
complete physical examination. Roentgenology and laboratory data add to, or con-
firm, the clinical impression gained from the history and physical examination but
can never replace the information gained from the patient. The history gives much
information if it is developed so as to present the symptoms in the order of their
appearance. I prefer to obtain first the history of the present attack, in minute detail
and then to explore the past medical history for previous attacks, other abdominal
diseases, operations, menstrual history, etc. In analyzing the symptoms, pain is the
most significant. The site of the first pain often gives a clue to the location of the
lesion which may be marked by a more diffuse pain when the patient is seen by the
doctor. The following case illustrates this statement.
A 52 year old male was taken suddenly ill in a movie with abdominal pain in the
left lower quadrant. He went home immediately, having vomited several times en-
route, and was admitted to the hospital several hours later. On examination, he
exhibited diffuse abdominal pain and rigidity, most marked in the epigastrium and
the left lower quadrant. Air was demonstrated under the diaphragm in the roentgeno-
graph, and a diagnosis of ruptured ulcer was made. At operation, the patient was
found to have a ruptured sigmoid diverticulum.
The colicky remitting pain of smooth muscle spasm is easily recognized, and the
radiation or reference of pain to specific anatomic areas is often an aid to diagnosis.
Testicular pain in renal and urethral lesions and the reference of pain to the angle of
scapula in biliary colic are familiar examples. The agonizing pain associated with a
"frozen attitude" is characteristic of the diffuse abdominal contamination of perfora-
tion. If the abdominal pain is not localized, the lesion is usually not one demanding
surgical care.
Nausea and vomiting are, in themselves, not diagnostic signs and symptoms. They
may occur with many extra-abdominal as well as intra-abdominal diseases. When
nausea and vomiting occur with diarrhea and abdominal pain, the cause is more
likely to be medical than surgical. The character of the vomitus may help in the diag-
nosis. The colics usually cause vomiting of gastric contents with bile staining. Strangu-
lation of gut or cysts often causes retching with little vomitus. The vomiting with
obstruction is true regurgitation of gastric and later intestinal contents.
The physical examination should be thorough and not only confined to the ab-
domen. The simple inspection of the patient may give some indication of the under-
lying condition. The patient writhing in attacks of colic; the tense rigidity of the
patient with perforation; the shock-like quiet of the patient with strangulation or
pancreatitis, and the pallor of the bleeding patient are quite characteristic.
FERGUSON— ACUTE ABDOMEN 105
The degree of fever helps to differentiate intra-abdominal from extra-abdominal
causes of the acute abdomen, especially in the onset of the attack. It is rare that acute
abdominal pain ushered in with a chill and high fever is caused by an intra-abdominal
lesion. The lungs or genito-urinary tract should be under suspension.
A thorough physical examination should include the throat, heart and lungs, as
well as the abdomen. This is especially true if the symptoms are those of an upper
abdominal lesion.
Palpation of the abdomen probably gives the surgeon some of his most important
information. It is best begun at an area away from the pain, to gain an impression of
the normal, and to relieve the patient's apprehension. This is especially important in
children. As the area of pain is approached, the patient should be encouraged to tell
the examiner of tenderness and to differentiate degrees of tenderness, if possible.
When palpating the abdomen, the examiner should distinguish between muscular
rigidity, muscle guarding, muscle tension, tenderness, and rebound tenderness be-
cause each gives somewhat different information about the underlying pathology.
Muscular rigidity is a continuing contraction of the abdominal muscles and is an
indication of the spread of irritation or inflammation to the underlying parietal
peritoneum. It, therefore, indicates the site and degree of the intra-abdominal process
in most cases.
Muscle guarding is an involuntary contraction of the abdominal muscles when an
area of tenderness is pressed upon. It, therefore, is of value to localize the area of the
acute process, and it usually indicates that the process does not lie adjacent to the
abdominal wall.
Muscle tension is a finding elicited by a comparison of the tension on the two sides
of the abdomen. The difference in tension may be slight, but careful examination may
show it to be definite. This finding I have taken to result from an axon reflex, pro-
ducing slight muscular contraction via the somatic nerves of the involved cord seg-
ment. Increased tension may occur from either intra-abdominal or extra-abdominal
causes. It may be associated with hyperesthesia of the abdominal wall which must be
distinguished from deep tenderness.
Tenderness is a subjective finding demonstrated by pressure which increases the
tension in an area of inflammation. It is a localizing sign, and the area of maximum
tenderness usually overlies the area of maximum inflammation.
Rebound tenderness is a confirmatory sign by which pain is produced at an area
of inflammation by sudden release of pressure on the abdominal wall. The sudden re-
lease of pressure produces a sudden readjustment of intra-abdominal relations with
increase in tension in the inflammatory process.
In palpation of the abdomen, distinction must be made between true and voluntary
findings. These can often be distinguished by diverting the patient's attention while
the abdomen is being palpated. True findings are the same with repeated examina-
tions. Voluntary (false) findings change with each examination. In general, it may be
said that diffuse findings except when associated with true rigidity are usually indica-
tive of a non-surgical lesion, whereas localized findings usually suggest an acute
surgical process.
Along with these observations, a search should be made for the presence of masses
and palpable organs, and the effect of respiration on their movement should be noted.
106' BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Palpation should also include a search of the loins and costovertebral angles for
tenderness, muscle guarding, and a palpation of the inguinal and femoral areas for
masses and tenderness.
Rectal and vaginal examinations may also give valuable information that should
never be neglected in examining the acute abdomen. In rectal examination, an effort
should be made to have the patient distinguish between the discomfort caused by the
strange sensation of the finger in the rectum and the tenderness produced by pressure
on an inflammatory area. I believe the most information can be obtained by examin-
ing the patient on his back with his knees drawn up on the abdomen in what may be
termed the foetal position. In this position, the palmar side of the index finger can
palpate more easily the cul-de-sac, and the abdominal contents are pushed downward
toward the examiner. In other positions, the abdominal organs tend to fall away un-
less they are fixed. The finding of blood on the examining finger may be an added
observation of significance on rectal examination.
Auscultation of the abdomen gives much information. The hyperactive peristalsis
of normal gurgling pitch is indicative of a diffuse irritation of the intestinal tract.
Hyperactive peristalsis of high pitch is the telltale sign of the distended, usually ob-
structed gut. Absence of peristaltic sounds points to a diffuse involvement of the
peritoneal cavity when associated with other signs, and the degree of reduction of
peristalsis denotes indefinitely the severity of the inflammation. Peristalsis is usually
reflexly silenced in the early phases of strangulations such as twisted cysts or tumors,
volvulus, and hernias.
The examiner should be able to form at least a clinical impression with the informa-
tion obtained from the history and physical examination. The blood count and urin-
alysis add further light on the diagnostic problem. When positive findings are reported,
they must be explained in the diagnosis; but in my opinion, the most reliance is to be
placed upon the history and physical findings in making a diagnosis. Additional help
may be obtained from roentgenographs of the abdomen and chest in certain cases.
PRINCIPLES OF TREATMENT IN THE ACUTE ABDOMEN
Before discussing the symptoms and treatment of specific acute abdominal diseases,
I would like to mention two general principles that may be well applied in the treat-
ment of any acute abdomen.
(1) The emergency is rarely so urgent that the necessary time cannot be taken to
prepare the patient for operation. This means a restoration of fluid and electrolyte
balance, a typing and cross match for transfusion if it seems advisable and appro-
priate sedation.
(2) The operation performed should be the most simple surgical procedure which
will deal adequately with the lesion causing the emergency. Our only responsibility at
this time is to save the patient's life. If the operation performed can be both lifesaving
and curative without adding to the operative risk, as an appendectomy in perforated
appendicitis, it fulfills the requirements. On the other hand, if a curative procedure
should increase the operative risk, as a cholescystectomy in acute gallbladder disease,
the surgeon should keep lifesaving uppermost in his mind and delay the curative
procedure until more ideal conditions are obtained.
FERGUSON— ACUTE ABDOMEN 107
INFLAMMATION
The acute inflammations usually have a less rapid onset than many of the other
acute abdominal conditions. They are ushered in with a short period of malaise and
loss of appetite. At first, a mild peritoneal irritation shows itself as a periumbilical
pain, nausea, and vomiting. As the inflammation progresses, the pain shifts to the
area of inflammatory tension; local tenderness, muscle guarding, or rigidity are found
on examination.
Slight, slowly rising fever and leukocytosis complete the aspects of an acute ab-
dominal inflammation. The problem is then to diagnose the definitive inflammatory
lesion.
APPENDICITIS
This is the commonest acute abdominal inflammation and is responsible for fully
50 per cent of all emergency abdominal operations and for almost 90 per cent of acute
abdominal surgery in children. It must be considered in the diagnosis of any age, but
mostly in childhood and young adult life. The symptoms and local signs of appendici-
tis vary with the position of the appendix with relation to the cecum, surrounding
organs, and the peritoneum. Further, the position of the appendix varies with the
position of the cecum in its various degrees of rotation and fixation to the posterior
abdominal wall. Thus, if the appendix lies below the normally placed cecum against
the abdominal wall, the usual right lower quadrant pain, tenderness and rigidity are
found. If the position of the appendix is the same but it is covered over by ileum or
a thick omentum, the parietal peritoneum may not take part in the inflammation ;
and although tenderness is present, rigidity is absent. An appendix lying lateral to the
cecum gives local tenderness and rigidity in the loin and often at a higher level than
usual. If it lies behind the peritoneal reflection so that the early stage of peritoneal
irritation is absent, the periumbilical pain, nausea, and vomiting resulting from this
irritation are not noted, and the first symptoms appear in the right side. When the
appendix extends upward or lies under the liver because of non-rotation of the cecum,
upper right quadrant signs are produced which are often confused with acute gall-
bladder disease. When the appendix lies in the pelvis, the early pain is often epigastric
rather than periumbilical, and abdominal tenderness may be minimal as compared to
that elicited on a rectal examination.
The most common differential diagnosis is between appendicitis and acute gall
bladder disease in the upper right abdomen, and between pelvic appendicitis and pel-
vic disease in females.
To make the differential diagnosis between acute cholecystitis and appendicitis in
the short fat individual is often difficult, if not impossible, even with all the historic
facts and diagnostic findings at hand. The important thing is to recognize the acute
abdomen that demands surgical intervention. Either condition can be taken care of
if the incision is properly placed.
The differentiation between pelvic appendicitis and lesions of the female pelvis is
even more difficult and-more important because many female pelvic lesions are cured
without operation. There are some findings that point more strongly to the pelvic
lesions than to appendicitis. Acute pelvic inflammatory disease is really a pelvic
108 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD
peritonitis producing bilateral pelvic tenderness, pain on motion of the cervix, a
more rapid elevation of temperature and blood leukocytes, and a more diffuse ab-
dominal tenderness lower in the abdomen. The history and finding of a vaginal dis-
charge are common. All of these are more suggestive of pelvic disease than of appendi-
citis, and are usually absent in the latter. With all of this information at hand, I
believe the differentiation between appendicitis and pelvic inflammatory disease in
certain young females is the most difficult of all diagnostic problems in the acute
abdomen.
The occurrence of pain midway between the menstrual periods and a tendency for
the symptoms to become less rather than worse helps to differentiate a ruptured
graafian follicle cyst from appendicitis. Ruptured endometrial (chocolate) cysts and
cysts twisted on their pedicles are frequently diagnosed as pelvic appendicitis. This
is not a serious error. When the diagnosis between appendicitis and a pelvic lesion
cannot be made with certainty, I believe the performance of a laporatomy is safer
than a policy of watchful waiting. I have never seen any serious consequence result
from the removal of a normal appendix in a case of pelvic inflammatory disease.
The acute phase of regional ileitis is not infrequently confused with acute appendi-
citis. There is a similarity of symptoms and signs; and in this instance, the differential
diagnosis is worthwhile, because surgery can be avoided if regional enteritis is present.
The points in the differentiation that are helpful are several. Enteritis is invariably
known to cause a chronic diarrhea or frequent loose stools. This is infrequent with
acute appendicitis. A tender indefinite mass in the lower right quadrant may be
found with ileitis. This is less common in the case of early appendicitis. From a prac-
tical point of view it is often difficult if not impossible to differentiate between acute
appendicitis and acute regional enteritis with certainty. Under such circumstances,
an operation should be advised. There is considerable controversy over the surgical
procedure to be followed when one encounters a red, edematous ileum instead of an
inflamed appendix. Some surgeons fear secondary fecal fistula if the appendix is re-
moved in the presence of an acute ileitis. I have never seen a fistula develop following
appendectomy with inversion of the appendiceal stump, and I believe appendectomy
is safe unless the base of the cecum is involved.
In childhood, it is often difficult to rule out mesenteric adenitis as a cause of lower
right quadrant pain and tenderness. The history and findings very closely simulate
those of acute appendicitis. In a general way, the symptoms of mesenteric adenitis
are less acute, the pain is less marked, the tenderness less, and not quite so well local-
ized. One can usually examine the abdomen of the child with mesenteric adenitis quite
easily, whereas the child with acute appendicitis permits examination with reluctance
and apprehension. With the anxious parents demanding to know if the child has
appendicitis, I invariably recommend surgery because it is impossible to be sure
that the process is not appendicitis and because, I believe, that the most effective
treatment for mesenteric adenitis is appendectomy.
I have followed many of these cases and my experience has been that appendectomy
not only relieves the acute symptoms, but also seems to result in an improvement in
the general health of the child. The scrawny, complaining child who is often a feeding
problem generally seems to take a new lease on life after removal of his appendix for
mesenteric adenitis.
FERGUSON— ACUTE ABDOMEN 109
The treatment of appendicitis is appendectomy. If the patient is not seen until late
in the course of the disease when the condition is really a peritonitis or abscess, non-
operative therapy consisting of large doses of antibiotic drugs, intravenous fluids,
and intestinal intubation appears to give the best results. Delayed surgery to drain
abscesses will be necessary later.
ACUTE GALLBLADDER DISEASE
Acute cholecystitis occurs most often in early mid-life and in the relatively obese
patient. In the younger patient, the acute attack may be the first sign of gallbladder
disease; but in the older patient, a history of chronic indigestion, food intolerance, and
of attacks of biliary colic may be obtained. In almost every case, acute gallbladder dis-
ease occurs because of impaction of a stone in the cystic duct. The initial pain in the
right epigastrium with radiation to the back and the angle of the scapula gives way to
a tension pain in the upper right quadrant as the gallbladder becomes distended and
edematous. Subcostal tenderness appears more marked as the tense gallbladder is
forced against the examining fingers by deep inspiration. If the obstruction of the
cystic duct continues, the process may continue on to hydrops or empyema of the
gallbladder in younger people; but in the older age group, necrosis, gangrene, and
perforation of the gallbladder is the common course. Jaundice is present in at least one
fourth of the cases, and the temperature and white blood count vary with the progress
of the disease.
In the usual case, the diagnosis is not difficult, especially if typical symptoms and a
typical history are obtained. If the patient is seen for the first time late in the course
of the disease, in many cases a distinction must be made between ruptured peptic
ulcer and acute pancreatitis. Here, a detailed history of the early and of the previous
symptoms is of considerable aid if it can be obtained. The obese gallbladder patient
as compared to the thin ulcer type is suggestive but not diagnostic. In the early phase,
tenderness over-shadows the abdominal rigidity in acute gallbladder disease, whereas
the reverse is true of ruptured peptic ulcer. Roentgenographs of the abdomen in the
erect position may show gallstones in cholecystitis or air beneath the diaphragm in
ruptured ulcer. In late cases, where either may have progressed as far as to produce
a local peritoneal collection, the diagnosis may be impossible because the findings are
alike. Both diseases may be treated the same at that stage.
The differentiation between acute cholecystitis and acute pancreatitis may be most
difficult from a clinical point of view. They both occur most commonly in individuals
with previous symptoms suggesting gallbladder disease. The onset of an attack of pain
an hour or so after a meal is more typical of pancreatitis than of acute gallbladder
disease. The more sudden the acute epigastric pain, the more persistent the vomiting,
the more diffuse the tenderness extending across the abdomen to the left of the mid-
line, the more the likelihood of pancreatitis than cholecystitis. So, too, the bilateral
tenderness in the costovertebral angles, the pain in the back, and the relatively slight
degree of muscle guarding are more suggestive of pancreatitis. The definitive diag-
nostic study is the serum amylase, but even this may be elevated in cases of indisput-
able cholecystitis.
Pancreatitis is believed to be caused, in many cases, by reflux of bile in the pancre-
atic duct. Therefore, it would appear that drainage of the biliary tree by cholecystos-
110 BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD.
tomy would be worthwhile in cases where the patient seemed to be getting worse and
where a definite diagnosis could not be made because the amylase test was not avail-
able.
There is usually not the urgency for surgery in cases of acute gallbladder disease
as in appendicitis, ruptured ulcer, or intestinal obstruction/Time can be taken to
prepare these patients for operation as a rule; by gastric intubation, hydration, intra-
venous glucose and electrolytes, and the administration of penicillin. If the patient's
findings appear to be regressing and there is an elevation of blood amylase indicating
an associated pancreatitis, it may be wise to delay surgery. In older patients, how-
ever, decision for early operation is the best plan because necrosis and gangrene of the
gallbladder occur rapidly. In addition, associated pulmonary difficulties often arise.
No patient should be denied surgery because he is too sick. The gallbladder can be
drained easily, if necessary, under local anesthesia. The decision as to what is to be
done at the operation must rest with the operative findings. In a very ill patient of
70 with an acute gangrenous gallbladder, often nothing more than drainage of the
gallbladder and removal of the stones are indicated. It is important to remove the
obstructing stones in the cystic duct. In most cases, these can be dislodged backward
and removed with the other stones in the gallbladder. It often occurs that a single
stone is obstructing the ampulla of the gallbladder. Failure to remove the obstructing
stone results in a subsequent gallbladder sinus. If the acute gallbladder is drained
only, it may be wise to have the patient return for cholecystectomy at a later date.
In most patients, however, cholecystectomy can be performed and the common duct
explored if necessary, without increasing the operative risk. Cholecystectomy can
usually be performed more safely during the first 48 hours than later when the edema
of the gallbladder has been replaced by fibrosis.
PERFORATION
A perforation of a peptic ulcer is one of the commonest, acute upper abdominal
lesions in males. It may occur in younger people without any preceding history of
ulcer disease as a perforation of an acute ulcer. It more commonly appears in a
patient who has had a history of ulcer distress for many years. There is often a day or
two of increased discomfort which precedes the appearance of sudden pain in the epi-
gastrium. Depending upon the size of the opening, there may be a rapid leak of gas-
tric and duodenal contents into the abdomen, or there may be a relatively small leak.
The acid-pepsin contents which contaminate the peritoneal cavity are extremely irritat-
ing and produce the characteristic "frozen attitude" noted in these patients. They lie
holding themselves tense in a single position. Any movement, as turning over in bed,
is done with such caution and evident distress that the diagnosis can frequently be
made by simply observing the patient. Vomiting occurs as the result of the peritoneal
irritation but is not marked, as a rule. The temperature may be subnormal at first
and never very high. There is a definite pulse hurry.
On examination, the typical board-like rigidity is easily demonstrated in the upper
abdomen and in a wider area, depending on the spread of contamination. Peristalsis
is usually markedly reduced or absent. Because of the tendency of the contaminating
fluid to leak laterally above the colon and then downward between the ascending colon
FERGUSON— ACUTE ABDOMEN 111
and the lateral abdominal wall, the area of tenderness and muscle rigidity often is
found to involve the right side of the abdomen and may be quite marked in the ap-
pendiceal area. When the overlying liver has protected the anterior abdominal wall
from contamination from the leaking ulcer, these findings may lead to a mistaken
diagnosis of appendicitis. The presence of air between the diaphragm and the liver
in roentgenograph taken in the erect position establishes the diagnosis of ruptured
ulcer, but a negative film does not rule it out.
The differential diagnosis between acute cholecystitis and acute pancreatitis and
ruptured ulcer has already been mentioned. In a typical case, there should be no con-
fusion. In a late case the diagnosis may be impossible. The important thing is to
diagnose the acute peritonitis and to treat it.
Perforations of peptic ulcers will respond well to simple closure of the perforation if
the operation can be performed early. The danger is from a continuing leak with pro-
duction of widespread peritonitis. The indication is to stop the leak and prevent the
peritonitis rather than to treat the ulcer. The abdomen is opened through an upper
right transverse incision, displacing the rectus muscle medially. Closure of the perfor-
ation by plugging the opening with omentum, held in place with sutures, gives ex-
cellent results. Aspiration of the fluids from the abdominal cavity and closure without
drainage is a treatment of choice. Postoperatively, gastric suction, antibiotics, and
intravenous fluids are administered until peristalsis is resumed. This is a program that
gives a low mortality rate. The patient who still has his ulcer must be treated for it
after recovery from perforation.
If the patient is not seen until more than 24 hours have passed following the perfo-
ration, the problem of the associated peritonitis over-shadows that of the perforation.
Experience has shown that the mortality is high with surgery for diffuse peritonitis
and that better results are obtained with a regime of continuous gastric aspiration,
intravenous alimentation, and massive doses of antibiotics. When walling off and
localization occur, abscesses may require drainage and more definitive surgery re-
served for a later date.
PERFORATED SIGMOID DIVERTICULUM
Perforation of a diverticulum of the colon, most commonly of the sigmoid colon,
usually occurs without any antecedent history as an acute lower abdominal pain
associated with, nausea and vomiting. In many cases, the process is an erosion and
eventual rupture of the diverticulum into the free peritoneal cavity, so the process is
really a peritonitis from the onset. The redundancy of the sigmoid loop which may
permit this structure to lie any place in the lower abdomen from the left lower
quadrant to well past the midline toward the right, accounts for the variability of the
point of maximum tenderness and leads to confusion in diagnosis. The fact that a
spreading peritonitis is present from the first, explains the high fever and leukocytosis
that occurs early in the disease. Since diverticuli are uncommon before the age of 40,
and occur with increasing frequency after that time, the diagnosis of perforated
diverticulum should be considered in all cases of acute lower abdominal pain in the
older age group.
Although any acute abdominal lesion may at times be confused with acute per-
112 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
forated diverticulum, acute appendicitis and acute diverticulitis are the two condi-
tions that must be most often differentiated from it. It is important to make this dis-
tinction, if possible, because, opening the abdomen through a gridiron incision may be
wrong if the lesion is a mis-diagnosed appendicitis. Conservative treatment may be
employed if diverticulitis is present. There are a few points that help in the differ-
ential diagnosis. Perforated diverticulitis is a rapid process, producing diffuse abdom-
inal tenderness and blood leukocytosis of 15,000 to 30,000 per cu. mm. within a
relatively few hours. The signs and symptoms are usually slower in development,
more definitely localized, and the leukocytosis is not so marked in appendicitis.
Diverticulitis usually is associated with signs of colon irritability, diarrhea, crampy
pain, and left lower quadrant tenderness. These signs and symptoms usually develop
over a period of days. If perforation and peritoneal abscess occurs, the signs become
more marked but localized to the area of inflammation.
There is usually no question about the necessity for operation in the acute ab-
domen resulting from a perforated diverticulum. There is some disagreement among
authors as to the proper way of treating these cases. We have the following rules. If
the perforation is of a single diverticulum without inflammatory change in the bowel,
the diverticulum may be excised or inverted and the hole in the bowel closed. A drain
is usually inserted at the site. If the diverticulum is a part of an inflammatory mass or
abscess, drainage is instituted. The real difference of opinion concerns the advisability
of a complimentary colostomy or cecostomy. We believe that fecal diversion or colon
decompression is indicated only when the lesion is associated with obstruction.
INTESTINAL OBSTRUCTION
The patients with intestinal obstruction usually present such typical symptoms
early in the course of their disease that the diagnosis should not be difficult. Colicky
pains in the abdomen, a history of no passage of feces or gas per rectum, are charac-
teristic symptoms. When these are associated with the active high-pitched peristaltic
sounds of a distended gut, the diagnosis is almost sure. The roentgenologic demon-
stration of gas-filled loops of gut and the fluid levels in the erect position are prac-
tically diagnostic. Vomiting and abdominal distention are later symptoms and they
depend, to some extent, upon the site of obstruction. As time goes on, a diagnosis
becomes further complicated by strangulation and interference with the blood sup-
ply of the obstructed gut. The appearance of strangulation adds new symptoms to the
clinical aspects, such as local tenderness, fever, and blood leukocytosis. In addition,
the inability to take fluids by mouth, and the loss of fluid by vomiting as well as into
the distended gut produces marked systemic dehydration with electrolyte and nu-
tritional imbalance. In former days the dictum was preached: "Never let the sun go
down on a case of intestinal obstruction. The longer a case of intestinal obstruction
lives before operation, the shorter he will live after the operation." The point was
well taken. It the patient can be operated upon and his obstruction relieved early,
before fluid and electrolyte disturbances and vascular damage to the gut have taken
place, the chances of early recovery are good.
The difficulty lies in that the patient frequently is not seen until several days
of obstruction have passed and he is already in a serious condition.
FERGUSON— ACUTE ABDOMEN 113
In dealing with cases of intestinal obstruction, it is important to make a diagnosis
between obstruction of the large intestine and that of the small, because the treatment
in somewhat different. From an analysis of 210 cases of intestinal obstruction in
patients over 60 years of age, we were surprised to find that at least two-thirds of the
obstructions occurring in the small gut resulted from hernias. I should judge that a
greater percentage appear in younger age groups. Because of this high occurrence
of strangulation of hernias as a cause of small intestinal obstruction, in every case
of small gut obstruction, regardless of the age, the patient should be suspected of
having a strangulated hernia. A Richter's type of hernia in the femoral opening in
older people is a common cause of small gut obstruction. This is diagnosed with diffi-
culty because the hernia is so small that it cannot be palpated. On numerous occasions
even with the abdomen open, I could not palpate such a hernial mass. The important
thing is to make the diagnosis of small gut obstruction and to operate before gangrene
and peritonitis make their appearance. A history of previous operations, especially of
pelvic surgery in females, and other operations requiring drainage, makes one
consider mechanical obstructions from intra-abdominal adhesions.
It is important to make the diagnosis of small intestinal obstruction demanding
operation. The exact cause of the obstruction may be evident, as in a strangulated
hernia; but in many instances, the cause may not be apparent until the abdomen is
opened. Although it is recognized that those patients require early operation, a few
hours spent in overcoming the electrolyte and fluid imbalance may pay great divid-
ends. In addition, the decompression of the gut by the Miller-Abbott tube may be
carried out at the same time.
In operating for a small gut obstruction, except those resulting from hernia, the
operative procedure is varied according to the condition of the patient. If this condi-
tion is good, an exploratory laparotomy may be performed, usually through a lower
midline incision. The collapsed small gut is picked up at the ileocecal valve, traced up-
ward to the site of obstruction, and dealt with as the occasion demands. If gangrenous
or non-viable gut is found, resection and primary end-to-end anastomosis has proved
to be the most successful method of therapy in our hands. In the extremely ill patient,
with obstruction of long duration, any general exploration of the abdomen is to be
avoided. The only operative indication is to decompress the gut. If this can be accom-
plished by the Miller- Abbott tube, we are justified in delaying operation. On the
other hand, if the Miller- Abbott tube fails to pass the pylorus and advance downward
into the small gut, it is preferable to perform a simple enterostomy by picking up and
opening a loop of the distended gut in the lower left abdomen through a gridiron
incision. This may be done under local anesthesia. After the gut is decompressed, the
abdomen may later be explored and the obstruction dealt with definitively.
Acute obstruction of the large intestine is most often caused by a malignancy,
usually located in the left side of the distal colon. The failure of passage of gas or feces
and the distention of the colon with gas and fluid are characteristic clinical and roent-
genologic findings. Small gut distention may not occur if the ileocecal valve is compe-
tent; hence, decompression by the Miller- Abbott intubation is not nearly as success-
ful in large gut obstructions as is true in small gut obstruction. Often a carefully
given barium enema may reveal the point of obstruction.
114 BULLETIN OF THE SCHOOL OF MEDICINE. U. OF MD.
The indication for treatment in small gut obstruction, as in large gut obstruction,
is the adjustment of fluid and electrolyte balance and decompression of the colon.
Definitive surgery must be deferred to a later date. We still prefer to decompress the
colon by simple tube cecostomy. This may be performed under local anesthesia
through a gridiron incision even in seriously ill patients. Although this may appear to
be a temporary and emergency measure, it frequently happens that with decompres-
sion the edema about the obstructing tumor subsides, and feces and gas pass the
obstruction in two or three days. Definitive surgery should be delayed until the pa-
tient has recovered from the effects of an obstruction.
MESENTERIC THROMBOSIS
Thrombotic or embolic occlusion of the mesenteric vessels presents one of the most
striking pictures of the acute abdomen. Fortunately, it is relatively rare, and for this
reason is misdiagnosed more often than not. The sudden onset of central abdominal
pain which is severe and constant is the usual characteristic feature. Depending on the
extent of the thrombosis, faintness or even shock may be present. In addition to the
constant pain, severe exacerbations of a colicky type of pain occur with repeated
vomiting so that the diagnosis of intestinal obstruction is usually entertained.
Examination shows a pale restless patient with blood pressure near shock level.
Tenderness and rigidity of the abdominal wall indicate a diffuse abdominal irritation,
but intestinal sounds may be increased. A rectal examination may reveal blood on the
finger, or the return of an enema may be bloody. This is almost diagnostic.
Mesenteric thrombosis is frequently misdiagnosed as acute hemorrhagic pancreati-
tis, ruptured ulcer, acute gallbladder disease, and intestinal obstruction. With a care-
ful history and diagnostic studies, the mesenteric thrombosis should at least be con-
sidered among the diagnostic possibilities.
The clinical features are so striking that operative intervention is usually impera-
tive as soon as the patient can be prepared. The escape of blood stained fluid as soon
as the abdomen is opened and the appearance of the black hemorrhagic gut makes the
diagnosis certain. Resection of the involved gut is the only hope of cure. We prefer
end-to-end anastomosis because it takes less time and needs but one suture line.
Exteriorization of the infarcted gut has proved unsuccessful in our hands. Post-
operatively, anticoagulants and antibiotics help to prevent further thrombosis and
complications of infection.
SUMMARY
In dealing with a patient with an acute abdomen, it is important to recognize early
the dangerous possibilities inherent in his condition. He should be taken to a hospital
where he can be given the benefits of thorough study and surgical consultation. It may
be impossible to make an exact diagnosis, but it is more important to recognize that a
surgical lesion is present. Surgical exploration should be looked upon in many cases
as a diagnostic method as well as a therapeutic procedure. The fundamental principle
in dealing with these acute abdominal surgical emergencies is to carry out the simplest
operative procedure which will deal with the lesion which creates the emergency.
PENICILLIN IN BRONCHIAL ASTHMA*f
HOWARD M. BUBERT, M.D.
The part played by respiratory infection in initiating asthmatic episodes and in
prolonging them in cases primarily caused by specific agents is larger, in our opinion,
than is usually believed. Further, it is our conviction that infection is almost solely
responsible for those cases presenting, from time to time, intractable asthma which
responds little, if at all, to conventional anti-asthmatic procedures usually dramatic-
ally effective.
The introduction of the antibiotics placed at the disposal of the profession agents
of incalculable value in controlling infections. Those usually occurring in the respir-
atory tract, being, as a rule, of a mixed type, are less responsive than infections with
a susceptible organism. However, with adequate dosage, surprisingly good results
can be obtained at times, and a significant number of respiratory infections can be
controlled sufficiently to terminate severe and distressing asthma, occurring as a
result of such infection.
Because the problem of controlling respiratory infection in these individuals loomed
so large, and because the methods currently used presented disadvantages, ranging
from the need for hospitalization to discomfort and costliness, it was our desire to
evolve a method of treatment that would avoid these disadvantages insofar as such
was practicable. Several criteria were established as being desirable; namely, the
introduction of a potent drug, the use of a drug that was not excessively expensive,
and a method of administration that involved a minimum of discomfort and in-
convenience.
The depository type of penicillin preparations seemed best suited for our purpose
because, if a prolonged effect could be obtained, the number of injections required
would be reduced. In addition, in our attempt to secure and maintain the maximum
possible concentration of penicillin in the body of the patient, we administered
enormous doses in the hope that their action might be further prolonged. Also, we
desired a form of the drug that was not too expensive. It was deemed necessary to
use a preparation that caused the least possible discomfort and the fewest possible
untoward reactions.
Initially, several types of penicillin were used. These consisted of a procaine peni-
cillin in peanut oil, aluminum penicillin by mouth, and a "fortified" procaine peni-
cillin in peanut oil to which was added penicillin G. In addition, and in a few cases,
a depository type penicillin which required more frequent administration was given;
but the added number of doses plus the discomfort resulting soon caused us to
abandon this material. It seemed to offer no advantages, but to offer distinct dis-
advantages. Likewise, the number of untoward reactions occurring from the use of
crystalline penicillin, in our experience, caused us to avoid these preparations.
* From the Section of Allergy, Department of Medicine, University of Maryland School of Medi-
cine.
Shirley W. Correll, Technician, assisted in this study.
t Received for Publication January 12, 1951.
115
116 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
As will be shown later in this study, more and more reliance was placed upon the
procaine penicillin that gave the most prolonged action because it seemed to us
definitely more effectual, caused few, if any, local reactions, and few untoward re-
actions of a general nature. The aluminum penicillin, within a very narrow field,
seemed to be of value although many times it was not effectual, and resort to the
most frequently used type was necessary.
Initially, it was our hope that properly selected cases would respond with pro-
longed relief to a course of this antibiotic, arbitrarily given at a set time. These
cases, along with a group of untreated cases studied as controls, were observed over
a period of months. Careful chest examinations and vital capacity estimations were
done periodically, and the bacterial flora of the sputum was repeatedly determined.
However, no changes of significant importance resulted in these cases except for the
immediate improvement experienced during the period of therapy.
Because we were dissatisfied with these results, this method was discontinued;
and we shifted the emphasis of our study toward the prevention and treatment of
acute respiratory infection. Cases were selected because the patient was in the midst
of an acute respiratory infection associated with bronchial asthma, or because their
history showed a marked tendency to have asthma whenever an acute respiratory
infection was contracted.
Our method was to have patients report to the office or clinic promptly when res-
piratory infection occurred. If (after careful consideration of their history, questioning
as to the immediate infection, temperature readings, and chest examination) bron-
chitis was found, they were given penicillin. A further requirement was that asthma
be present or that its occurrence be likely, in view of our past experience with the
patient under consideration.
If these criteria were satisfied, the drug was administered in one of the following
ways.
Depo-Penicillin:* 1,200,000 units (4 cc.) were injected into the buttock and re-
peated every 3 or 4 days for several doses until the infection was controlled or until
the procedure seemed to be ineffectual. In children, the doses were reduced pro-
portionately to their age with 600,000 units (2 cc.) being the minimum dose given.
Aluminum Penicillin:^ Originally these cases were given a course of 32 tablets,
50,000 units per tablet, over a period of 4 days in an effort to duplicate the total
number of units in the injectable material administered at any given time. However,
we found that it did not control the infections adequately; consequently, the number
of doses was increased to 5, the fifth dose being given during the night.
Depo-Penicillin {Fortified):* This drug was administered in 1 cc. doses (400,000
units) when a respiratory infection occurred and was repeated every three days for a
total of three doses, if such was necessary.
Our results were classified as Good, Fair, and Poor. "Good" indicates that an
episode of bronchitis and asthma was terminated promptly; if bronchitis was present
alone, then it was terminated and asthma did not occur. "Fair" indicates definite
* Generous quantities of this drug were supplied by the Upjohn Company; Kalamazoo, Michigan
t Generous quantities of this drug were supplied by Hynson, Westcott, and Dunning; Baltimore.
Maryland.
BU BERT— PENICILLIN IN BRONCHIAL ASTHMA
117
improvement that would not have been expected in a given patient when the past
history of that patient was given critical consideration. "Poor," obviously, represents
a failure to abort or to terminate asthma in the face of a given infection.
TABLE 1
Depo-Penicillin (300,000 u/cc.)
Depo-Penicillin (Fort.) (400,000
u/cc.)
Aluminum Penicillin (50,000 u/tab.)
NO. OF
NO. OF
CASES
EPISODES
50
68
16
17
14
14
AVG. DOSE
GOOD
RESULTS
3.5 cc.
1 cc.
32 tabs./
course
47
9
6
FAIR
RESULTS
10
3
3
POOR
RESULTS
11
5
5
Consideration of the foregoing figures reveals that the plain, unfortified, deposit
type of penicillin achieved good results in 69 per cent of 68 episodes. Fair results
occurred in 15 per cent of 68 episodes, and poor results in 16 per cent of 68 episodes.
With the fortified type deposit penicillin, 17 episodes were treated with definitely
smaller total dosage as advocated by the manufacturer. Here 53 per cent good
results were obtained; 18 per cent fair results; and 29 per cent poor results. With the
aluminum penicillin by mouth, 14 episodes were treated with 43 per cent good results;
21 per cent, fair results; and 36 per cent, poor results. Attention is called to the fact
that in these latter cases, the "good" results obtained occurred in children with one
exception.
It seems obvious from these findings that the method under discussion, namely,
large doses of a plain, deposit type penicillin, represents the method of choice.
Because hospitalized cases usually represent severe, intractable asthma that the
attending physician has been unable to control at home, it was thought worthwhile to
compare hospital admissions, comparing two successive twelve-month periods. Our
experience here is as follows.
TABLE 2
February 1, 1948 — February 1, 1949
Our Cases 24 (Avg./month — 2)
All Other Cases 66 (Avg./month— 5.5)
Total 90
February 1, 1949 — February 1, 1950
Our Cases 11 (Avg./month — 0.9)
All Other Cases 36 (Avg./month— 3)
Total... ' 47
It will be noted that our cases were reduced in number 54 per cent, and the ad-
missions of all other physicians in the same hospital, 45 per cent, showing a 9 per
cent greater reduction in our cases. The overall reduction in admissions of severe
asthma was 47 per cent. Furthermore, from the experience shown by all cases of
severe asthma admitted, it is obvious that antibiotics have probably accounted for
the more favorable total admission rate experienced in the latter year shown above.
118 BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD.
Parenthetically, it may be mentioned that, occasionally, we encountered cases of
asthma unresponsive to penicillin. In these, it was our practice to resort to the use of
other antibiotics. In some instances, they have proved effectual. However, their
greater cost, together with the tendency of one of them to cause untoward reactions
in a considerable number of patients, militates (in some degree, at least) against their
routine utilization.
SUMMARY
We were interested in evolving a simple and inexpensive method of controlling
infectious asthma with as few untoward reactions as possible. A depository type
penicillin, in large doses, was administered to infectious asthmatics in the midst of
respiratory infection. Fortified depository penicillin and aluminum penicillin, by
mouth, were also utilized.
CONCLUSIONS
1. The method outlined would seem to be a satisfactory one for the control of a
large percentage of episodes of infectious asthma.
2. It would seem that the antibiotics have contributed to the reduction of asth-
matic attacks of sufficient severity to warrant hospitalization, no matter what
method of administration was used.
A NEW TYPE PULL-OUT WIRE FOR TENDON SURGERY:
A PRELIMINARY REPORT*
ARLIE R. MANSBERGER, JR., M.D.. ERVVIN R. JENNINGS, M.D.,
EDWARD P. SMITH, JR., M.D. and GEORGE H. YEAGER, M.D.
Basic problems in successful tendon repair are: accurate approximation of the
severed tendon without tension, immobilization and prevention of formation of
surrounding cicatrix. Various techniques and types of suture materials have been
devised in an attempt to minimize surgical trauma and to reduce the use of foreign
materials.
To evaluate and compare results, a standard form has been adopted at the Uni-
versity Hospital. An attempt is now being made to evaluate various methods of ten-
don repair. It is the purpose of this paper to describe a new barbed pull-out. wire
suture and discuss the technique for its use.
Description
The suture consists of a braided tantalum wire with a weldon curved cutting needle
at the proximal end, and a weldon straight cutting needle at the distal end. It is
approximately 42 centimeters long with a semi-flexible weldon barb approximately
12 centimeters from the curved needle or proximal end. The barb points toward the
distal end of the suture. The original wire of twisted stainless steel was unsatisfactory
because of lack of pliability, f The tantalum wire suture now being used is extremely
flexible, has excellent tensile strength, and is easily removed. %
Technique
After identification of the severed tendon ends, the straight needle is introduced
through the center of the proximal segment, starting a varying distance from the cut
end and threaded through until the barb is engaged. Engagement of the barb is
facilitated by a slight downward pull of about 90 degrees to the direction of the tendon
fibers. Careful engagement of the barb prevents tearing of the tendon. The straight
needle is then threaded through the center of the distal cut tendon end for a varying
distance and brought out through the skin. Traction on the distal end of the wire
further engages the barb and pulls the proximal tendon distally, affording easy ap-
proximation of the cut edges. Handling and maceration of the lacerated edges is re-
duced to a minimum. The distal end of the wire is then fixed over a button placed
next to the skin. Tension sufficient to maintain good approximation is exerted.
* From the Department of Surgery, University Hospital and University of Maryland School of
Medicine, Baltimore, Maryland.
Received for Publication May 10, 1951
t Developed by Dr. Med. Fritz Lengemann, an Austrian surgeon.
% The braided tantalum barbed pull-out wires were supplied to us by the Ethicon Company. We
wish to express our thanks to Dr. Herbert F. Davis and Mr. Zoller of the Ethicon Company for
their cooperation.
119
120
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
By means of the curved cutting needle, the proximal end of the wire is brought out
through the skin and secured without tension over a button. The wound is closed in
lavers and the area immobilized bv external fixation.
Tied
Tied Tiqh+lu
Proximal Tendon.
Distal Tendon
Drawing showing details of suture (left), technique of use (bottom) and view of hand with
suture in place.
At the end of 21 days, the distal end of the wire is cut flush with the skin and the
wire removed by gentle traction on the proximal end. Fifteen barb pull-out wires have
been used in 10 patients, and no difficulty has been encountered in their removal.
This method of tenorrhaphy presents the following advantages:
1. Simplicity.
2. Xo tissue constrictive factors.
3. Minimal foreign body implant with minimal tissue reaction.
MANSBERGER, ET A L— WIRE FOR TENDON SURGERY 121
4. Surgical trauma and maceration of the cut tendon ends is reduced to a minimum.
5. Internal immobilization of the proximal end of the cut tendon is provided by
means of a single suture.
6. Removal is easy.
Summary
A new braided tantalum barbed pull-out wire suture and the technique for its use
is described.
A companionate article Tendon Forms for Use in the Treatment of Severed Tendons" by
Erwin R. Jennings, M.D., George H. Yeager, M.D. and Otto C. Brantigan, M.D. will appear in a
forth-coming edition of the Bulletin.
TORULOSIS OF THE CENTRAL NERVOUS SYSTEM: BIOCHEMICAL
BEHAVIOR OF THE CAUSATIVE ORGANISM *f
WILLIAM H. MOSBERG, JR., M.D. and JAMES D. McALPINE, Ph.D.
INTRODUCTION
In 1916 Stoddard and Cutler (1) in their monograph placed the pathology and
clinical aspects of central nervous system torulosis on a firm basis. Since that time
the causative organism has been widely studied and extensive descriptions of its
macroscopic and microscopic appearance and cultural characteristics may be found
in the recent literature (2). Other investigators have clarified the life cycle of the
organism (3), its nutritional requirements (4) and the chemical composition of the
capsule of the organism (5). The biochemical behavior of the Cryptococcus neqfor-
mans has remained a source of controversy. With the exception of studies made by
Harrison (6), Fitchett and Weidman (7) and Cox and Tolhurst (2), the opinions of
various authors have varied from "no fermentation of carbohydrates" (8, 9, 10,
11, 12, 13, 14) to "slight if any fermentation of carbohydrates" (15, 16, 17, 18).
In this study an attempt was made to obtain as many different strains of Crypto-
coccus neoformans isolated from the human central nervous system as possible and
study the reaction of these strains on a series of carbohydrate media.
METHODS
The material used as inoculum was obtained from the central nervous systems
of 30 different patients who were suffering from torulosis. These subcultures were
tested for purity by both plating and direct examination of stained smears. Cultures
from 6 to 7 days old, growing on Sabouraud's media, served as the source for inocu-
lating the media used in this study.
Twenty-eight sets of media were then inoculated with each of these subcultures.
Fermentation tests were made using 1 per cent concentrations of the carbohydrates.
Uninoculated tubes of the various media served as standard for comparison of the
color. All inoculations were made in duplicate. Following inoculation the media were
incubated at 38 C. for 24 hours and, following this, kept at room temperature. Ob-
servations were continued for 90 days.
RESULTS
The results obtained in the 30 strains studied are presented in Table I. It is note-
worthy that no strain formed gas and that every strain fermented dextrose. Media
frequently fermented in this study were sucrose, galactose, levulose, d-mannose,
rhamnose and trehalose. No fermentation was noted on erythritol, inositol or adoni-
tol. Each of the strains exhibited different biochemical characteristics.
* From the Departments of Neurosurgery and Bacteriology, University of Maryland, School of
Medicine, Baltimore, Maryland.
Aided by a grant from the Hoffberger Neurosurgical Fund,
t Received for publication December 26, 1950.
122
3S01VH3HI
i I+ + + +I l + l 1 1 I+ + +I++I I3+I+ + +I 1 1
0
q
loiiNoav | 1 I 1 1 1 1 1 1 1 1 1 I 1 I 1 I I I I I I I I I I | | | | |
asoMHJva sllssll'slllll + IIIIIIIIIIIIiril
o o o o o
1 O Q o - q Q
NiiaNi
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 + 1 1 1 1 1 1 1 1
3S0NNYHH
+ 1 1 1I+I+1+ + +1+ + +1 + 1 1 + 1 + 1 1 1+ + +1
0 0
q ft
asoiovivo + l'§l+ + + + + + + + + +l + l+ + + + + + :§+l + l 1 1
CO o
o q a
taiasav
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 r 1 1 1 ■§ 1 +•§ 1 1 1 1 1 1
0 0
q q
ioii3iaa
1 1 1 1 1 1 1 1 1 1 I lis 1 1 "§ "§ 1 1 1 1 1 1 1 1 1 1 1 1 1
0 00
q q q
NIDI1VS
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 H 1 + 1 1 1 1 1 i 1 1 1 1 1
0
q
asoNiavav -i j | | | | | | | | | | | | | | | | | | + | | | | | | | | | | . |
xiaixaa
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 + 1 1 1 1 1 1 1 1 1 1 1
toiisoni
1 1 1 1 1 1 1 1 i" 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
10XIHHIAH3
1 1 1 i 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
iviiauos-a
1 • 1 1 1 1 1 1 •§ 1 1 1 1 1 1 1 1 1 -§ 1 1 i- 1 f 1 1 1 1 1 1 .1
0 0
q q
asoinAai 1 +l+ + + +lllllll 1 1 1 1 1 l+ll 1 1 1 1 1 1 i |
ooooo o oo
PPQQQ q Q Q
asoiovivo-a J 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
aiamos Hoavis
1 1 1 1 1 1 1 1 + 1 1 1 1 1 1 1 1 1 '•§ 1 1 1 1 1 1 1 -1 1 1 1
0
q
asoNNVK-a
!i + + + + ! + + !!+ 1 1 1 1 1 +I + + 1 +1 1 ! i!i!
0 000 0 000
p. p, a q q qqq
asoiAX-a
Doubt
aioaxi
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .1 1 1
Niiviao
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
asoaons
+ 1 ++ + + + + + + + 1 I + I+ + + +I + I I+ + + +I 1 +
asoiAX
Doubt
31IK SMIH
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ! 1 1 1 1 1 1 1
aXINNVH
Doubt
Doubt
Doubt
Doubt
asoiovi j I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 + 1 1 1 1 1 1 1 1 1 1 1
asoi-ivn 1 ll+l+l 1 lll+ + +l++l + l 1 II 1 1 1 1 1 1 +
000 00
q q q q q
asoxixaa | + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
aNoiaaa:
SgSSSSSSSS§§S2§S§§22§SS§S2§SSS
^Hr^^u^oooO'^csPO^inor--ooO'OT-'cq-*in\Or--coO'-«fSf^r#io
55 £
C/3 <
II II
Q <
3 .WJ
§ c/3
§ ^
123
124 BCLLETIX OF THE SCHOOL OF MEDICINE— U. OF MD.
DISCUSSION
Harrison (6) was probably the first to divide torula and mycotorula into groups
according to their sugar fermentations. In his study the organisms were divided into
9 groups according to their reaction on carbohydrate media. His results were not
confirmed by this study.
In a comprehensive investigation Fitchett and Weidman (7) employed 20 strains
of torula from cerebrospinal cases and found that: "dextrose and levulose were fer-
mented by all 20 strains; dextrose and levulose alone were fermented by 7 of the
strains; dextrose, levulose and saccharose were fermented by 4 strains; inulin,
dextrose, levulose, saccharose and melitose were fermented by 2 strains, and these
5 sugars and mannite by 2 strains." Weidman in an earlier paper (19) stated that the
higher concentration of sugar in carbohydrate media seemed to hasten the reaction
and cause a definite amount of gas to be formed in some of the sugars.
More recently Cox and Tolhurst (2) have studied 10 strains from their cases and
have concluded that: "The fermentative power of Torula histolytica is weak and
variable." They suggested that the biochemical behavior varied according to the
time which had elapsed since isolation of the organism.
Weidman in 1933 (19) made the statement: "It appears from this that such dif-
ferences in acid production cannot be invoked to create new species of this Torula, at
least at the present time." This study, carried on sixteen years later and employing
organisms isolated from many cases diagnosed since that time, confirms that opinion.
Acknowledgments : The authors are indebted to Drs. John Wagner and Frank Hachtel for their advice and encour-
agement and to the many laboratories and clinics for their contribution of subcultures without which this study could
not have been undertaken.
SUMMARY
1. A study was made of the biochemical behavior of the organism isolated from
the central nervous system of 30 patients suffering from torulosis.
2. In no instance was gas formed, but each strain fermented dextrose. Other
frequently fermented media were sucrose, galactose, levulose, d-mannose, rhamnose
and trehalose. Erythritol, inositol, and adonitol were not fermented by any of the
strains.
3. Each strain studied exhibited a different biochemical behavior.
REFERENCES
1. Stoddard, J. L., and Cutler, E. C: Torula infection in man. A group of cases, characterized
by chronic lesions of the central nervous system, with clinical symptoms suggestive of cere-
bral tumor, produced by an organism belonging to the torula group (Torula Histolytica, N.
Sp.). Stud. Rockefeller Inst. Med. Res., 25: 1-106, 1916.
2. Cox, L. B., and Tolhurst, J. C: Human torulosis, pp. 1-142, Melbourne University Press,
Carlton, N. 3, Victoria, Australia, 1944.
3. Todd, R. L., and Herrmann, W. W.: The life cycle of the organism causing yeast meningitis.
J. Bact., 32: 89-103, 1936.
4. Schmidt, E. G., Alvarez-Dechoudens, J. A., McElvain, X. F., Beardsley, J., and Tawab,
S. A. A.: A microbiological study of cryptococcus neoformans. Arch. Biochem., 26: 15-24,
1950.
5. NrNO, F. L.: Contributions to the study of the blastomycoses in the Argentine Republic. Bol.
Inst. Clin. quir. B. Aires, 14: 591-1014, 193S.
MOSBERG AND McALPINE— TORULOSIS 125
6. Harrison: Quoted by 14.
7. Fitchett, M. S., and Weidman, F. D.: Generalized torulosis associated with Hodgkin's disease.
Arch. Path., 18: 225-244, 1934.
8. Burger, R. E., and Morton, C. B.: Torula infection; review and report of four cases. Surgery,
15: 312-325, 1944.
9. Frothingham, L.: A tumour-like lesion in the lung of a horse caused by a Blastomyces (Torula).
J. Med. Res., 3: 31, 1902.
10. Kessel, J. F., and Holtzwart, F.: Experimental studies with torula from a knee infection in
man. Amer. J. Trop. Med., 15: 467-483, 1935.
11. Mitchell, L. A.: Torulosis. J. A. M. A., 106: 450-452, 1936.
12. McGehee, J. L., and Michelson, I. D.: Torula infection in man. Surg. Gynec. Obstet., 52:
803-808, 1926.
13. Rappaport, B. Z., and Kaplan, B.: Generalized torula mycosis. Arch. Path., 1: 720-741, 1926.
14. Weis, J. D.: Four pathogenic torulae (Blastomycetes) . J. Med. Res., 2: 280, 1902.
15. Johns, F. M., and Attaway, C. L.: Torula meningitis, report of a case and summary of litera-
ture. Amer. J. Clin. Path., 3: 459-465, 1933.
16. Levin, E. A.: Torula infection of central nervous system. Arch. Intern. Med., 59: 667-684,
1937.
17. Longmire, Jr., W. P., and Goodwin, T. C: Generalized torula infection, case report with
observations on pathogenesis. Johns Hopk. Hosp. Bull., 64: 22-44, 1939.
18. Taber, K. W.: Torulosis in man; case. J. A. M. A., 108: 1405-1406, 1937.
19. Weidman, F. D.: Cutaneous torulosis, the identification of yeast cells in general in histologic
sections. South. M. J., 26: 851-863, 1933.
GOUT— RECENT ADVANCES
EDWARD S. McCABE, M.D.*
The word "gout" has been adapted from the Latin etymon, gutta, which implies
a drop or coagulation. It is descriptive of the articular dyscrasia thought to be caused
by a defluxion of humors into affected joints. The chalky tophus is essentially a large
accumulation of sodium urate crystals with the initial lesion a microscopic gutta of
urate.
Hippocrates in 400 B. C. is credited with the first recorded description of podagra
(attacks foot, Greek) although it seems probable that Hieron recognized the malady
prior to that. Aretaeus added much to the description of the symptom complex, and
Alexander of Tralles made a significant advance (sixth century A. D.) with the suc-
cessful use of colchicum autumnale. It was not until 1820 that Pelletier (1) isolated
the alkaloid colchicine from this herb. For modern history of gout see Chart I.
There is increasing interest in human genetics and in the early detection of car-
riers of hereditary disease. Talbott (2) observed 136 blood relatives of 27 gouty pa-
tients and found no roentgenologic evidence of gout. However, 25 per cent were
found to have hyperuricemia, and 80 per cent of these were male. Steelier and later
Freyberg came to the conclusion that hyperuricemia results from a single autosomal
dominant gene, and only a small percentage of the heterozygotes manifest gouty
arthritis. Thus the homozygotes are prone to go on to tophaceous gout. Also, there is
evidence now to show that a similar relationship holds as regards hypercholesterol-
emia and xanthoma lesions. In addition, about one-third of the patients show both
errors in metabolism.
The incidence of gout is roughly 5 per cent of all cases of arthritis seen at the large
general hospitals and clinics. Thus, there are about 350,000 cases in the United
States. Sex, age, climate, and occupation are additional predisposing factors.
Metabolism: Purine nitrogen is excreted as urate because no enzyme is present in
man to oxidize urate to allantoin. Uric acid is partially endogenous. About 200
mgms. are excreted daily on a purine-free diet with an adequate caloric intake. Nu-
cleoproteins are the principal source. The primary exogenous sources are liver, kid-
ney, thymus, pancreas, sardines and anchovies. Of the bases, thymine, cytosine, and
uracil are the pyrimidine bases which form urea as the nitrogenous end product. On
the other hand, adenine and guanine (purine bases) are deaminized and oxidized to
form hypoxanthine and uric acid. The maximum solubility of sodium urate in dis-
tilled water is 100 mgm. per cent; but in the presence of saline, it is reduced to | or
Yo, depending on other ions present; yet the solubility in body fluids is somewhat
higher, and hence the existence of a colloidal form is suggested. Talbott feels that
98 per cent of patients with gout irrespective of the phase, will show a serum
uric acid above 6 mgms. per cent, just the reverse of a control group. In the urine
the more alkaline it is the greater the solubility. However, for a given pH the more
sodium ions, the less soluble are the urates. One must keep excretion at less than 50
mgms. per 100 cc. of urine. There is a higher value in gouty subjects for the ratio,
* 133 S. 36th Si., Philadelphia, 4, Pennsylvania
126
McCABE— GOUT— RECENT ADVANCES 127
serum urate concentration _. ,. . , . , . . . .
— : — . lhus, there may be a selective constitutional intenoritv
urine urate concentration
of the kidney in its ability to concentrate urate. Synovial fluid is in agreement with
serum urate concentration. The only exception is the spinal fluid which represents
60-80 per cent of the serum level.
Renal clearance is calculated as the volume of plasma needed to carry the quantity
of the substance excreted per minute. For inulin or mannitol a normal person forms
125 cc. glomerular filtrate although only 2 per cent reaches the urinary bladder.
Ninety per cent of urate in glomerular filtrate is reabsorbed, so that renal clearance
is about 10 cc. per minute. Urea is about six times greater. This applies to gouty sub-
jects as well. Urate clearance tends to be maintained at the expense of per cent re-
absorption as glomerular filtration rate is impaired in gouty patients by progressive
damage. Retention of urate from kidney damage is manifest only when glomerular
filtration rate is depressed below 35 cc. per minute.
See (3) in 1875 was the first to observe that salicylates increased urate excretion.
It is probable that while the tubules are busily engaged in the excretion of salicylate,
they are unable to give proper attention to resorption of urate. The action of cincho-
CHART I
HISTORICAL REVIEW
SYDENHAM 1683 Differentiation of gout from other joint diseases.
SCHEELE 1776 Identified uric acid in a kidney stone.
WOLLASTON 1797 Discovered uric acid in tophi.
PELLETIER 1820 Isolated colchicine from the meadow saffron.
GARROD 1848 Discovered hyper uricemia.
MIESCHER 1871 Nucleoproteins in cell nuclei.
KOSSEL 1891 Purines are building stones of nucleic acid.
FISCHER 1907 Chemical structure of uric acid and purines.
FOLIN 1913 Method for uric acid determination in blood.
KOCH 1939 Method for determination of "true uric acid" with uricase.
ALDERSBERG 1942 Abnormal uric acid partition (ultra filtration).
SMYTH 1948 Genetics of gout and hyper uricemia.
HENCH 1949 Pituitary Adrenocorticotropic Hormone.
phen is probably the result of a mildly toxic activity to the renal tubular cells. Colchi-
cine has no demonstrable effect in urate clearance. Salygan® does have an effect as
does Diodrast®, p-amino hippuric acid and Caronamide®. Glucose at high plasma
levels takes precedence over urate reabsorption.
There appears to be a gout cycle starting with a diminished excretion of urate; then
a gain in body weight accompanied by diuresis. A drop in barometric pressure pre-
cedes the latter. Harkary (4) recently emphasized the allergic aspect of the chemical
manifestations with the joints as the major shock tissue. Experiments in the rat
have shown (Selye) that anaphylactic reactions from egg white can be inhibited by
injections of ACTH and cortisone, while Desoxycorticosterone acetate (D.O.C.A.) in-
creases the mortality. Also formaldehyde arthritis can be minimized or exaggerated by
the above agents. The hypo-activity (5) of the adrenal cortex with reference to the
11 oxysteroids in the prodromal period may be responsible for release of inhibition
128
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
of the xanthine oxidase in the liver and hence to rise to serum uric acid (Chart II). In
phase 4, despite innumerable liver function tests, the only consistent abnormality is
a high blood fibrinogen which would account for the increased sedimentation rate.
The low keto steroid excretion may be caused in part by an unsuccessful attempt to
convert to 11 oxysteroids.
Urate Deposition: The fact that the earliest changes observed at microscopic ex-
amination of joints are deposits of urate in the upper layer of cartilage, suggests
that urate comes from synovial fluid rather than directly from the capillaries of bony
structures. Focal necrosis is unlikely because of the long span of life and synovitis,
unless allergic, is not seriously entertained. Urate deposits are prone to develop in
avascular tissues with the exception of the kidney. Fibrous ankylosis may follow ex-
tensive erosion and destruction of the cartilage. A tophus has 60 per cent urate, 30
per cent organic material, and 10 per cent cations, mainly sodium. It may be as-
sumed that urate deposits in apposition to bony trabeculae inhibit osteoblastic ac-
tivity; and as bone is resorbed normally, it is not replaced in the immediate vicinity
of a tophus. The exostoses are characteristic of degenerative joint disease and may
be associated with calcium deposition but are not necessarily a part of gouty joints.
CHART 11
FIRST
STAGE
Phase 1
Phase 2
ARTHRITIS Early attacks of
Later and more fre-
acute recurrent
quent attacks but
arthritis
still complete re-
missions.
HYPERURICEMIA
Transient
+
+
TOPHI Generally absent
+
0
—
SECOND STAGE
Phase 3 Phase 4
Residual joint disease.
Exacerbations or Late, relatively
active chronic ar- painless, inactive
thritis. residual arthritis.
+ +
+
+ +
+ +
ulceratim
Gout would appear to be the result of an inborn error of metabolism, which at
some time or other manifests itself as a hyperuricemia and/or gouty arthritis. The
tophaceous form and chronic arthritis is more likely to be seen in the individual
with a double gene defect (6). Certain factors involved in endogenous uric acid me-
tabolism are (1) diminished destruction, (2) diminished excretion, and (J) increased
formation. The last would appear the most likely if a threshold is exceeded, over-
taxing the first two factors. It appears that the alarm reaction precipitated by emotion,
infection, surgical procedures, and drugs, i.e. liver extract, physical exertion, allergy
and alcohol or dietary indiscretion with the resulting outpouring of steroid hormones,
especially if dissociation with D.O.C.A. in preponderance is possible, will disturb
metabolism enough to account for all symptoms. An allergic factor on a consti-
tutional diathesis may be the synergist that magnifies small changes in the
desoxycorticosterone . _,. , ,„. , , . . . , , .,
—-■ — — — — ratio, I itch (/) has shown verv nicelv that svnovial permeabil-
11 oxysteroid
ity is increased by D.O.C.A. and hyaluronidase and that cortisone, artisone, and other
McC. 1 BE— GOUT— RECENT A D YA NCES
129
11 oxysteroids decrease permeability. It has been shown before that any increase in
sodium ions at a given pH necessarily decreases urate solubility. Thus, since the
pituitary is probably under "hormostatic control", a large single dose (8) such as 50
mgms. of adrenocorticotropic hormone (A.C.T.H.) may ameliorate acute gout by
creating a more favorable ratio since it stimulates primarily the mid zone or oxyster-
Fig. 1. (Top) : Roentgenograph showing mild gouty arthritis of hand
Fig. 2. (Bottom) : Roentgen photograph showing advanced gouty changes
oids, thus helping mainly at the many sites of inflammation or by covering the lag
period until the D.O.C.A. falls low enough to again stimulate the pituitary.
The first attack (Stage I) of acute gouty arthritis usually occurs suddenly, lasts
about 3 to 10 days, and then disappears completely. It affects a great toe or with al-
most equal frequency an instep, ankle, knee, or other region. The typical attack may
130 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
come on at night and the pain, moderate at first, increases in severity. Often the
weight of the bedclothes adds to the patients' distress. On examination the affected
joint is swollen and exquisitely tender. The skin is a deep color, almost purplish, and
veins are prominent. There is often local itching and some desquamation as swelling
subsides. Hyperuricemia may or may not be present.
The disease usually increases in tempo and severity, attacks coming semi-annually
or more often. Later attacks (Stage II) are prone to be polyarticular and febrile.
Despite this, the joints recover full symptomless function. The stage of chronic gouty
arthritis begins after a variable period of time, i.e., ten years or so. At first, exacerba-
tions are superimposed with incomplete remissions. Then these cease, and there
exists a relatively painless chronic arthritis. At some time all the patients with ex-
acerbations show a hyperuricemia, but in the chronic stage the sedimentation rate
is a much better guide as to activity than the uric acid level which is within normal
limits. With the polyarticular stage, subcutaneous tophi and involvement of bursae
are rather common. Osseous tophi may be demonstrated in chronic gouty arthritis.
Fig. 1 and2.
One aspect (9) of this disease that has not been emphasized enough is the mental
side. This is more frequently seen in phase 3 of the disease when the patient's memory,
especially, for recent events, is impaired, as is the ability to calculate. The speech
then becomes thick, garbled, or slurred. The individual may become quite irritable.
This does not appear to be on a toxic drug basis, as the clinical signs disappear while
the patient is still under therapy.
Complications may arise in the cardiovascular-renal system. Nephritis and renal
colic occur in about one-fifth of the cases in the second stage. It would appear that
degenerative vascular complications are more frequent in gout, especially when asso-
ciated with arteriosclerosis. The differential diagnosis would therefore include rheu-
matoid arthritis, osteoarthritis, intermittent hydroarthrosis, menopausal arthritis,
palindromic arthritis, and erythema nodosum.
Treatment: The important points in treatment are an early recognition and pro-
phylaxis which includes demonstration of symptomless hyperuricemia. The early
monarticular attack may be aborted by taking a saline cathartic and the use of
colchicine, gr. j-^-, every 2 hours for 6 or more doses. This may be followed by so-
dium salicylate gr. XX 4 times daily or cinchophen gr. VII ss 3 times daily for a
few days to combat hyperuricemia. If the attack becomes established, bed rest with
a cradle to keep the weight of the bed clothes from the affected part is needed and
should be maintained until pain and tenderness subside. Warm compresses are usually
more effective than cold. The colchicine must be pushed to toxic dose level although
once this is known, on subsequent attacks the patient may stop a few tablets short
of the toxic level. Paregoric or codeine may be necessary to control the diarrhea result-
ing from colchicine. Aldersberg (5) believes that colchicine lowers the bound uric acid.
It seems that one could use the difference in the determinations of spinal fluid uric
acid and serum uric acid as the protein-bound portion and thus easily prove the
validity of this hypothesis with simultaneous determinations before and after insti-
tution of therapy.
At times a narcotic as strong as morphine gr. j may be necessary to relieve the
MCCABE— GOUT— RECENT ADVANCES 131
pain of gout. The diet should be low in purines and fats and high in carbohydrate.
Alcohol should be avoided. Cocoa which contains theobromine is preferable to tea
and coffee as the latter yield uric acid.
The fact that the patient has a gouty diathesis and must adhere faithfully to the
interval treatment needs to be stressed. The diet may be individualized but should
be free of purines 3 days a week and low (200 mgms.) on other days. If an allergic
background is evident, then those substances should be avoided at all times. There
seems to be evidence that an increased vitamin requirement exists, particularly
thiamine demands. Acetylsalicylic acid gr. XX three times daily, alternating with
Chlor-Trimeton® -A mgm. three times daily, seems to be a useful interval regimen.
The gouty patient should always carry a few colchicine tablets along for prompt use
as necessary.
Cinchophen® therapy is a calculated risk since it is very effective in lowering
serum uric acid. It is necessary to maintain a good urinary output, i.e., 1500 cc.
daily, and to insure an alkaline urine. Potassium Citrate gr. XX three times daily
may be used in order to prevent precipitation of urates bringing about renal colic.
The cases of liver damage from cinchophen appear to have occurred in cases of rheu-
matoid arthritis that were misdiagnosed. In chronic gouty arthritis fever therapy,
using typhoid vaccine may be required. If tophaceous ulcers occur, a careful debride-
ment usually results in prompt healing. One should always institute the above regi-
men to prevent post-operative exacerbation. In gouty nephritis, a low protein diet
and a more generous fluid intake are demanded in addition to other measures. Lith-
ium salts greatly increase the solubility of urates in vitro but have been disappointing
clinically. The pituitary adrenocorticotrophic hormone (10) has been shown to in-
fluence uric acid excretion and probably both solubility and partition. It is able to
hasten the control of the acute attack probably by substituting for the lag period in
the thermostatic type, control of the pituitary gland for its release. The final result
awaits more intensive clinical trial. A.C.T.H. can precipitate an attack if given in a
remission period. Cortisone does not appear to be of as much value as the adrenals
tend to become atrophic under this therapy.
CONCLUSION
The later in life the gout develops, the better the prognosis. It would appear that
the disease only progresses rapidly in the individuals who do not enter wholeheartedly
into a therapeutic regime.
BIBLIOGRAPHY
1. Pelletier & Caventou., Examen chimique de plusieurs vegetaux de la famille des colchicees
et du principle actif qu' ils renferment, Ann Chim. Phys., 1820, XIV, 69.
2. Talbott, J. H.. Serum Urate in Relatives of Gouty Patients, J. Clin. Invest: 1940, XIX, 645.
3. See, G., Etudes Medicales sur l'acide salicylique et les salicylates, Bull. d. TAcad. d. Med.: 1877,
VI, 689.
4. Harkary, J., Allergic Factors in Gout, J.A.M.A., 139: 75, 1949.
5. Robinson, W. D., Conn, J. W., Block, W. D., and Louis, L. H., Role of the Adrenal cortex
in Urate Metabolism and in Gout, Proc. Central Soc. Clin. Research 21, 23, 1948.
6. Aldersberg, D., Newer Advances in Gout, Bull. New York Acad. Med., 25, 651, 1949.
132 BULLETIN OF THE SCHOOL OF MEDICINE. U. OF MD.
7. Fitch, D., Personal Communication.
8. Margoles, H. M., and Caplan. P. S., Treatment of Acute Gouty Arthritis, J. A.M. A. 142,
256, 1950.
9. Wilson, G., Personal Communication.
10. Hench, P. S., Kendall, E. C, Slocumb, C. H., and Polley, H. F., Effects of Cortisone Acetate
and Pituitary A.C.T.H. on Rheumatoid Arthritis, Rheumatic Fever and Certain Other Con-
ditions. Arch. Int. Med. 85. 545. 1950.
PERFORATION OF GASTROJEJUNAL ULCER FOLLOWING SUBTOTAL
GASTRIC RESECTION FOR DUODENAL ULCER*f
Case Report
EMIL BLAIR, M.D. and OTTO C. BRANTIGAN, M.D.
Baltimore, Maryland
It is of unusual interest that the first report in the literature of a gastrojejunal
ulcer was that of a perforated ulcer (14). As a complication following surgical treat-
ment of peptic ulcers, gastrojejunal ulcers occur less frequently following subtotal
gastric resection than after gastro-enterostomy alone. In the order of diminishing
frequency, the site of perforation of anastomotic ulcers appears in the jejunum, at the
anastomosis, and finally in the stomach (13). The greater majority of perforated
ulcers open into the free peritoneal cavity, although a small number communicate
with the bowel to form fistulas. Toland and Thompson (13), in a review of 103 case
of perforated anastomotic ulcers, found that only six communicated with the bowel.
These authors also found that most fistulas occur following gastro-enterostomy,
whereas marginal ulcers follow subtotal gastric resection and are more likely to per-
forate into the free peritoneal cavity (19).
The following case is presented because, as far as is known, this is the first instance
reported in which there was perforation at the site of the stomach in a gastrojejunal
ulcer following subtotal gastric resection for duodenal ulcer. This perforation pene-
trated into the free peritoneal cavity.
Case Report
B. C, a 47 year old negro male was admitted to the surgical service of the Baltimore City Hos-
pitals on April 6, 1948, with a chief complaint of "pain in the stomach" of six months' duration.
The symptomatology and clinical findings were fairly typical of duodenal ulcer. A roentgenologic
examination revealed distortion of the duodenal cap caused by an ulcer and by spasm of the duo-
denum and pylorus. Surgery was recommended because of the severe persistent pain, and a subtotal
gastrectomy of the Polya type and an antecolic gastro-enterostomy were performed. The ulcer
proper was removed by the resection. The patient withstood the procedure well; and following the
customary progressive dietary regimen, he was discharged on the eleventh postoperative day.
He was followed for seven months in the Out-Patient Department. During this time, he was
entirely free of symptoms. Then he was not seen for a period of nine months, at the end of which
he was admitted to the accident room, presenting signs indicating an acute surgical abdomen. Twelve
hours previously, he had been seized suddenly with severe pain in the right upper quadrant. The
distress soon spread over the entire abdomen. Two hours later, he noticed an aching pain in his left
shoulder. On physical examination the blood pressure, pulse, and temperature were found to be
normal. The positive findings were limited to the abdomen which had a boardlike rigidity and was
generally tender. An upright roentgenogram of the abdomen revealed air under the diaphragm.
The patient was taken immediately to the operating room where a laparotomy was performed.
There was a moderate amount of free peritoneal fluid present, but only a small amount of contam-
inant. A perforation 3 mm. in diameter was found in the stomach just above the site of the anas-
tomosis. The perforation was closed with an invaginating suture of No. 00 chromic catgut and then
* From the Department of Surgery, Baltimore City Hospitals, Baltimore.
f Received for Publication, August 19, 1950.
133
134
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
reinforced with silk. An omental tag was sutured over the site of the perforation. The patient toler-
ated the procedure well, and his postoperative course was uneventful.
Inasmuch as the factors which had produced the ulcer were still present, further
treatment was obviously indicated. To avoid a possible recurrence of this distressing
complication, a trans-thoracic bilateral vagectomy was performed. Again the surgery
was well tolerated. Repeated insulin-induced hypoglycemic gastric analyses revealed
no free acid. The patient was asymptomatic during hospitalization. Roentgenographic
studies revealed normally functioning anastomosis and no evidence of ulcer. The
patient was discharged on the twenty-first postoperative day after the second oper-
ation. A hypoglycemic study made four months later again revealed no free acid.
The patient has hid no recurrence of symptoms to date, eight months after dis-
missal.
Fig. 1. This is an illustration of the site of the perforation in the stomach, just adjacent to the
anastamosis.
DISCUSSION
It has been estimated that about 1 per cent of gastrojejunal ulcers perforate (13).
In 1936 To land and Thompson (13) reported 93 instances of perforated anastomotic
ulcers found in the literature. They added 10 of their own, making a total of 103.
In 1938 Bracci (2) recorded 200 cases, and Warren and Fallis (15) reported 17 more
in 1944. Ogilvie (8) added another in 1947, and in 1948 3 additional cases appeared
in the literature (6, 9). Easton and Cole (3) reported 1 instance in 1949, as did
Lurje (7). Although there are certainly more instances of perforated marginal ulcers
than those reported, a search of the literature revealed only 239 cases including the
case report discussed here. The greater majority of perforations occurred in ulcers
following gastroenterostomy. This is to be expected because gastroenterostomy
is more frequently complicated by anastomotic ulcer than subtotal gastrectomy.
The conditions that produce duodenal ulcers will produce gastrojejunal ulcers;
i.e., hyperacidity, hypersecretion, and hyperactivity. In addition, there are the
factors of sensitivity of the jejunal mucosa, the role of infection, the presence of
obstruction, and the finesse of surgical technic. The choice of doing an anterior or a
BLAIR AND BRANTIGAN—GASTROJEJUNAL ULCER 135
posterior anastomosis and the length of the loop may be contributing factors. The
locale of the perforations would be in direct proportion to the most common locale
of gastrojejunal ulcers. These occur most frequently on the efferent limb of the
jejunal anastomosis and most rarely in the stomach.
A perforated marginal ulcer presents an emergency problem. The quickest and
simplest treatment is the best. In an instance where an adequate subtotal gastrec-
tomy has been performed, the choice of a simple closure is obvious. In short, the
treatment is similar to that prescribed for perforated duodenal ulcer. Where only a
partial gastrectomy has been done, dismantling of the anastomosis and resection
are advocated (7, 13, 15, 17). Uncomplicated gastrojejunal ulcers lend themselves
to various methods of treatment (5, 7, 11).
When the ulcer has been closed and the patient has recovered, there should be no
delusion concerning the final end results. The distressing factors that produced the
ulcer still persist, and further perforation can occur. The conditions threatening
further ulceration must be eradicated. In this connection, the role of the vagus re-
section is believed to be of great value. Vagotomy has even been advocated as the
sole treatment of uncomplicated gastrojejunal ulcers (4, 18). The rationale, in its
application for treatment of gastrojejunal ulcers, is identical to that applied to
gastroduodenal ulcers. In the wake of experience with perforated ulcers, vagotomy
is an essential and mandatory procedure. Thus, vagotomy serves not simply the
beneficent role of a valuable adjunct, but assumes a major role in the prevention of
recurrence of gastrojejunal ulcers.
SUMMARY
1. A case of a gastrojejunal ulcer perforating into the free peritoneal cavity 16
months following subtotal gastrectomy is presented.
2. Treatment consists of simple closure of the ulcer, followed by transthoracic
vagectomy.
3. A brief review of the literature concerning perforated gastrojejunal ulcers is
presented.
BIBLIOGRAPHY
1. Benedict, E. B.: Jejunal ulcer. Surg., Gynec. and Obst, 56: 807, 1933.
2. Bracci, U.: Perfazione in peritoneo libero di ulcera peptica insorta dope resezione. Arch. ed.
Atti. d. Soc. Ital. di Chir., 44: 994, 1938.
3. Easton, W. H. and Cole, W. H. : Precautions and results in gastrectomy. Arch. Surg., 59:
768, 1949.
4. Garxock, J. H. and Lyons, A. S.: The surgical therapy of duodenal ulcer. Surgery, 25: 352,
1949.
5. Jtjdd, E. S. and Horner, M. T.: Jejunal ulcer, Ann. Surg., Ill: 1003, 1935.
6. Lowdon, A. F. R.: Gastrojejunal ulceration, Edinburgh Med. J., 55: 553, 1948.
7. Lurje, A. : Treatment of perforated gastrojejunal ulcer by resection of stomach and anastomo-
sis. Arch. Surg., 58: 281, 1949.
8. OGiLvrE, H: Gastrectomy : A human experiment, Lancet, 2: 377, 1947.
9. Plenk, A. and Zechman, A.: The surgical treatment of duodenal ulcer. Wien. Med. Wschr.,
98: 238, 1948.
10. Prtestly, J. T. and Gibson, R. H.: Gastrojejunal ulcer: clinical features and late results. Arch.
Surg., 56: 625, 1948.
136 BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD.
11. Ransom, H. K.: Treatment of jejunal ulcer, Arch. Surg., 58: 684, 1949.
12. St. John, F. B., et. al.: Results following subtotal gastrectomy for duodenal and gastric ulcer.
Ann. Surg., 128: 3, 1948.
13. Toland, H. K. and Thompson, H. L.: Acute perforation of gastrojejunal ulcer. Ann. Surg.,
104: 827, 1936.
14. Braun, W.: Quoted by Toland, T K. and Thompson, H. L.: Acute perforation of gastrojeju-
nal ulcer. Ann. Surg., 104: 827, 1936.
15. Warren, K. W. and Fallis, L. S.: Perforation of postoperative jejunal ulcers. Surgery, 15:
569, 1944.
16. Wilkie, J. P. D.: Jejunal ulcer. Ann. Surg., 99: 401, 1934.
17. Rienhoff, W. F., Jr.: An analysis of the results of surgical treatment of 260 consecutive cases
of chronic peptic ulcer of the duodenum. Ann. Surg., 121: 583, 1945.
18. Trimble, I. R. and Lynn, D. H.: The surgical treatment of duodenal, gastric, and anastomotic
ulcer, with especial reference to vagus resection. Surg., Gynec. and Obst., 90: 105, 1950.
19. Klingenstein, P.: Gastrojejunocolic fistula. Surg. Clin. North America, 27: 315, 1947.
CLINICO-PATHOLOGIC CONFERENCE
From the Case Histories, University Hospital, Baltimore
Clinical History
A 49 year old white male was admitted to the surgical service of the University
Hospital because of a spot on his lung. On April 17, 1950, he had a roentgenograph of
his chest taken by a mobile x-ray unit and 6 weeks later was advised to have a larger
film taken. He was told then that he had a "spot" on his lung, and hospitalization
was advised. He denied having any chest pain, hemoptysis, cough, or night sweats.
The patient smoked 2 or 3 cigars per day but had gained weight recently. He had
been told that he had tachycardia and high blood pressure. There was no evidence of
dyspnea, palpitation, and ankle edema. In 1927 he had had an attack of gonorrhea.
The remainder of the past history was negative.
His father died of appendicitis at the age of 58. His mother, 76 years old, was living
and well. There was no family history of heart disease, tuberculosis, cancer, diabetes
or asthma.
The patient was a well developed, moderately obese, middle-aged, white male.
There was no evidence of dyspnea, cyanosis, jaundice or edema. The pupils were
round, equal, and central and reactive to light. Accommodation was normal. The
trachea was in the midline, and there was no tug. The thyroid was of normal size.
There was no cervical venous distention or lymphadenopathy. The axillary lymph
nodes were not palpable. The lungs were clear to percussion and auscultation. The
area of cardiac dullness was extended to the left anterior axillary line. The sounds
were regular in rate and rhythm. There were no murmurs. The abdomen was obese.
There were no palpable viscera, tendernesses, masses or spasm.
Laboratory data included the following determinations: Blood hemoglobin con-
centration was 110 per cent, (16.1 grams); hematocrit, 45 mm.; and blood urea nitro-
gen, 14 mgm. per cent; blood sugar, 80 mgm. per hundred cubic centimeters of blood.
A urine specimen was yellow and acid. Its specific gravity was 1.018. A trace of al-
bumin was present. Two concentrated sputum smears stained for acid-fast organisms
were negative. Roentgen studies of the chest were repeated (Fig. 1).
On August 4, 1950, an exploratory thoracotomy was performed. Post-operatively,
the patient's course was satisfactory; and on August 16, 1950, he was discharged
from the hospital.
Clinical Discussion
Dr. William L. Garlick: We have the problem of a questionably healthy individual
who has hypertension and a slightly enlarged heart and a shadow or spot in his lung.
The word "spot" doesn't indicate "tumor" to me. In reviewing the statistics of mass
roentgenographs, one finds that some 30 to 40 types of lesions have been discovered.
On the basis of probability, one can make an almost exact diagnosis, since few symp-
toms were presented by this patient. The least common of the lesions demonstrated
by mass roentgenographic surveys are the neurologic tumors. A tumor arising in
nerve usually would cause neuralgia. There is pain that encircles the body in the
137
138 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
instance of neuroma Such was not reported in this case. Bone disease should be
considered. Pott's disease is not an uncommon condition, particularly in the 20 year
old group. The radiologic defect lies usually behind the heart and sometimes in the
mediastinum. Patients with this disease, however, do not feel well. They have symp-
toms of chronic illness. This man obviously had no chronic disease. Chondromas,
lymphomas, and plasmacytomas are seen occasionally in the ribs. I have had ex-
perience with metastatic tumors of ribs which had been "silent" and which were
found on ''plates" of the chest. I recall one rib tumor that turned out to be a metastasis
from a hypernephroma. Another patient whom I saw had 20 to 30 small metastases
in his left chest after pneumonectomy. He also had a hypernephroma. In both cases
there were no symptoms referable to the kidney. Tumors of the breast, colon, and
Fig. 1. Roentgenogram showing circumscribed area of increased density at periphery of right
lung.
oesophagus may metastasize to the chest before causing symptoms in the organ of
origin. In classifying radio-opacities of the lungs and mediastinum, one must con-
sider cardiovascular structures such as a dilated pulmonary conus, aneurysm, hyper-
trophied left auricle, and pulmonary infarcts. In hemangiomas and arteriovenous
aneurysms that occur in the lung, one usually finds a thrill over the anterior portions
of the second to the fifth ribs. One might think of coarctation of the aorta, but this
will usually give murmurs in the dorsum of the chest. An arteriovenous aneurysm
in the lung field with a cystic cavity that is visible radiologically would cause a thrill
or murmurs.
The physical examination here states that no murmurs or thrills were heard. On
routine roentgenograph ic films, a spot in the lower left or right chest close to the
CLINICO-PATIIOLOGIC CONFERENCE 139
heart border can be seen in patients who apparently are otherwise normal, but the
history reports that the patient has been in an accident. Hernias in the chest should
be thought of in such cases. In the anterior mediastinum, one might see a rounded
shadow that is typical of a teratoma or dermoid cyst. These tend to occur in the
mediastinum or near the pericardium. Occasionally, they will occur in the posterior
mediastinum. Patients with dermoid cysts usually have a history of some vague
complaint. For instance, we treated a woman who had a sensation of shifting weight
in her chest every time she leaned over. She had been treated for neuroses, but roent-
genographic studies revealed a large dermoid cyst. Because there was no lymphadenop-
pathy, I assume that Hodgkin's disease may be dismissed. Thyroid, parathyroid,
and pleural tumors are eliminated on the basis of their rarity and inconstant roent-
genographic characteristics. One of the more common lung lesions is solitary or multi-
ple cysts. These are usually discovered in younger people. They frequently have a
history of repeated attacks of pneumonia and pneumonitis, or else history of spon-
taneous pneumothorax is obtained. An emphysematous bleb or cystic cavity may be
seen in a roentgenograph. About 1 in 800 persons in a mass roentgenographic series
have congenital cystic lesions, but cysts of this type constitute the third largest
group of tumors that are discovered.
I think we can rule out most inflammatory lesions in this patient, because he did
not have a feeling of morbidity. Too, these inflammatory lesions are very easily
diagnosed by roentgenography. The most commonly encountered pulmonary disease,
(and the incidence is 1 out of 60 people) is tuberculosis. Its type may be a healed
tuberculosis, a Ghon tubercle, an early acute active tuberculosis, or a reactivation
of an old lesion. I think we can rule out bronchiectasis because this man did not have
cough or hemoptysis. The second most common group of lesions, particularly if they
are circumscribed, is primary bronchogenic carcinoma. The next most common
lesion in such a patient would be adenoma. In bronchoscopic clinics, we frequently
see adenomas that cause atelectasis and thereby throw a shadow. I want to emphasize
that every circumscribed lesion in the lung should be considered as carcinoma until
proven otherwise. I would pick as the first diagnosis on this patient a Ghon tubercle
or tuberculoma, because this is the most common lung tumor that causes a roent-
genographic shadow. The diagnosis that I would choose secondly is bronchogenic
carcinoma, and lastly, bronchogenic cyst.
Dr. D. J. Bamett: We called this lesion a tuberculoma. The lesion is about 1| cm.
in diameter, peripheral in the lung, and solitary. In the solitary lesion there are
plaques of calcification which are more dense at the center of the lesion than in the
periphery. The heart is slightly enlarged.
Senior Student: Is there a relationship between tuberculoma and malignancy?
Dr. D. J . Bamett: No. However, I have seen carcinomas arising in tuberculomas.
They usually arise in the periphery of the tuberculoma.
Dr. H. R. Spencer: I do not know of any definite relationship that might exist be-
tween the two. As Dr. Garlick has suggested, any inflammatory lesion or destructive
process of the lung may instigate squamous metaplasia which might be a site for the
development of squamous carcinoma. Some years ago I saw a man who gave a his-
tory of tonsillectomy and subsequent pain in his chest. Three years later, a lung
140 BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD.
lesion was found. It was thought that following the tonsillectomy he had an infected
embolus with infarction and lung abscess. At autopsy, he was found to have a car-
cinoma in the periphery of his lung, which had had its origin in the squamous lining
of an old cavity.
Senior Student: Did subsequent films in this case show that this lesion had grown
any?
Dr. Barnett: I can't answer that. This is the only film we have. The films made
elsewhere are not available to us.
Dr. R. C. Sheppard: One doesn't wait for tumors to increase in size. Take them
out and look at them.
Dr. R. M. Cunningham: Calcium in a peripheral lesion probably indicates a life-
long duration of the lesion. If one doesn't see any indication of calcification, remove
the lesion. In such a case, carcinoma cannot be ruled out by clinical procedures.
There has never been a carcinoma reported that had calcium in it.
Dr. Spencer: I would like to ask Dr. Garlick to comment on that point.
Dr. Garlick: My feeling is exactly that. With the assistance of films, one ought
to be able to show calcareous matter in most of these lesions. On the basis of one
film or a series taken in a short time, I see no reason to remove the tumor surgically.
If surgical treatment is needed to make a diagnosis, a segmental resection of the
lung should be performed. If the tumor should be carcinoma of the lung, a lobectomy
may cure the carcinoma as readily as a pneumonectomy.
Pathologic Discussion
The gross specimen, S.P. # 69662, in this case consisted of a small piece of lung
tissue which contained a round, well circumscribed encapsulated lesion that was ap-
proximately 2.5 cm. in diameter. The lesion consisted of a laminated caseous mass
which presented the characteristics of tuberculosis. Histologic sections showed casea-
tion surrounded by fibrous tissue. There was no evidence of recent activity.
Anatomic Diagnosis
Tuberculoma.
OBSTETRICAL CASE REPORT*
Mrs. R. E. was admitted to the hospital on May 23, 1950, in active labor and with the following
significant history. She had had 4 previous full term pregnancies and normal labors. All
of the babies lived and were healthy. There were no other pregnancies. Her present pregnancy was
characterized by more than the usual amount of abdominal pain, probably on the basis of muscle
relaxation. The estimated date of confinement was May 30. On the morning of the day of admission
the membranes ruptured spontaneously; and after a latent period of 4 hours, labor began. The
patient reached the hospital about 6 hours after rupture of the membranes. Abdominal palpation
at this time revealed a transverse presentation, the diagnosis being R.Ac. A. The fetal heart was
easily heard near the umbilicus; the rate was 140 and the sounds regular. A rectal examination was
most interesting in that the cervical canal was only about one half effaced and the external os about
3 cms. dilated. There was a loop of umbilical cord protruding through the cervix, but still within
the vagina. The pulsations in the cord were synchronous with those of the fetal heart. The estimated
size of the fetus was 3400 grs (7| lbs.). Her pains were 4 to 6 minutes apart and moderately severe.
The mother's condition was entirety normal.
Discussion: Thinking about the treatment of a transverse presentation has changed
considerably in recent years, especially since antibiotics have made abdominal de-
livery so much safer. For years the dangers of internal podalic version and breech
extraction were recognized; but in the treatment of certain cases of transverse lie,
it appeared to be the lesser of two evils. Most physicians could not bring themselves
to do a decapitation or another destructive operation on a living healthy baby and
deliberately accepted the increased risk to the mother which accompanied version
and extraction. All too frequently the results were bad. Fortunately, modern methods
of combatting infection permit the use of the abdominal route today under circum-
stances which would almost certainly have been fatal a few years ago. And the case
cited above is one in point. Abdominal delivery should be quite safe for this mother
and offers the best possible chance for the baby.
Since this is her fifth term pregnancy, and if cesarean section is to be per-
formed it will be undoubtedly more satisfactory for the patient if she does not con-
ceive again. Sterilization should be considered.
Actual treatment: Cesarean section and sterilization were performed. The patient
had a normal convalescence, both mother and child being discharged in good con-
dition.
* From the Department of Obstetrics, University of Maryland School of Medicine, Baltimore.
141
BOOK REVIEW
Methods in Medicine, 2nd Edition, 1950 (1st, 1924) George R. Herrmann, M.D., Ph.D., C. V. Mosby
Company, St. Louis
This book is a re-issue of The Manual of the Medical Service of Dr. George Dock published in
1924. It is apparently designed for the guidance of the intern in working up his cases and of the
clinical student in observing the way those patients are studied.
History taking and physical examinations are given a brief outline. Techniques and procedures
are briefly described for routine hematologic studies, urinalysis, examination of sputum, gastric
contents, spinal an paracentesis fluids, staining of bacteria, blood chemistry determination, and a
few other clinical tests. The brevity maintained in this 132 page section limits its interest to the
medical student and intern. They could be expected to have classroom notes outlining all the methods
described in this text.
To special studies in suspected infectious disease cases six pages are devoted. The specific tests
described in two or three paragraphs include the tuberculin test, the Kveim reaction (sarcoidosis)
the Schick, Dick, and brucellergin tests. A few other studies are mentioned.
Other chapters on various classes of disorders present special features of the history, physical
examination, and laboratory studies which are to be remembered and performed. These classes
include endocrine, metabolic, nutritional, allergic, pulmonary, cardiac, and the other systemic dis-
orders. Clinical pathologic testing comprises the bulk of material in this section.
The book ends with some general therapeutic procedures and practical dietetic methods for the
management of various conditions.
For the intern or practitioner who has limited time for brushing up on a large number of specific
laboratory tests, this book can have definite value.
Joseph H. Bird, M.D.
142
MEDICAL SCHOOL SECTION
DEPARTMENT OF PSYCHIATRY
Aided by a grant from the Bressler Research Fund of the School of Medicine, the
Department of Psychiatry has been engaged in a project relating to the study of
psychiatric education. The success experienced in the early stages of the project has
resulted in a decision to broaden the study into other fields of medical education.
The Department of Psychiatry plans to conduct a series of seminars led by com-
petent workers in the field of general education and medical education to discuss and
perhaps formulate the best available information as to the theories and practice of
medical school teaching.
The first seminar was held on April 16 at which time Dr. John R. Reid, Professor
of Philosophy at Stanford University, California, who is currently visiting Professor
of Psychiatry, initiated the seminar with a talk on "Human Values in Medical Edu-
cation."
The Department of Psychiatry will distribute copies of the Proceedings of these
seminars throughout the school year.
PROGRESS NOTE III
View of construction of new Psychiatric Building as of May 11, 1951
ii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
APPOINTED ASSISTANT PROFESSOR OF PHYSIOLOGY
The Department of Physiology has announced the appointment of Dr. John
McCullough Turner as Assistant Professor of Physiology, effective in August, 1950.
Dr. Turner was born in New York City on March 5, 1908, receiving his under-
graduate college training at Yale University and graduating in 1931. From 1932-33
he traveled extensively on the Continent and in 1934 entered the pre-medical de-
partment of Columbia University- In 1935 he entered the Cornell University School
of Medicine, transferring to the Yale University Graduate School at the end of the
second year. While at Yale, he was associated with Dr. Howard W. Haggard in the
department of Applied Physiology, receiving his Doctor of Philosophy degree in 1943
on the subject of "The Oxidation and Elimination of Exogenous Acetone." From
1942-45 he served as a Lieutenant in the United States Navy, conducting research
relating to physiologic problems associated with certain internal combustion en-
gines and certain noxious gases in closed ships' spaces. From 1946-49 he was Asso-
ciate Professor in the Department of Applied Physiology at Yale University, fol-
lowing which he served a year as Assistant Professor of Pharmacology and Physiology
at the University of Connecticut College of Pharmacy.
Dr. Turner is married and has two children.
Dr John McCullough Turner.
MEDICAL SCHOOL SECTION iii
FACULTY-STUDENT COUNCIL DINNER
Members of the Faculty and Student Council gathered on May 10th for the annual
Faculty-Student Council dinner.
This meeting, inaugurated almost 10 years ago and highly popular with the Student
Government, Administration, and Department Heads, provides a common meeting
ground for the exchange of constructive ideas to further student-faculty relations
and to discuss informally at dinner, problems arising in the student body which
perhaps would not otherwise be brought to faculty attention.
This year discussion centered principally about certain curriculum changes, the
possible introduction of the honor system for student examinations, and for a closer
faculty-student association.
A student plan for the elimination of grade consciousness was also presented for
faculty consideration. Presentations by class Presidents and the President of the
Student Council, Mr. William Matthews, were most constructive and entertained
considerable discussion from most of the faculty present.
Members of Student Government and Department Heads are shown at the annual Faculty-Student
Council dinner on May 10th
MEDICAL LIBRARY NOTES
Gifts continue to come to the library from generous alumni and other friends.
Between February 1 and May 1, the following donors presented material to the
library :
iv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Dr. Margaret B. Ballard Dr. Page C. Jett
Dr. H. K. Fleck Dr. Arthur M. Kraut
Dr. Frank W. Hachtel Mr. Morton Krieger
Mr. W. L. Holder Dr. H. B. McDonnell
Dr. H. Boyd Wylie
The Medical Library is benefited greatly from the revised and expanded exchange
list of the BULLETIN OF THE SCHOOL OF MEDICINE. Many significant new
periodical titles are being added to the library collection on an exchange basis. There
has been a good response from both foreign and domestic journals interested in
receiving the BULLETIN and providing the Medical Library with their publications.
The annual meeting of the Medical Library Association was held in Denver,
Colorado, at the end of June this year. Librarians in all divisions of the health
sciences attended this meeting, not only from every corner of the United States, but
from foreign countries as well. Each year the Schools of Medicine, Dentistry, and
Pharmacy of the University of Maryland have made it possible for their librarians
to attend the meeting and represent the libraries. This year, the librarian, Mrs.
Ida M. Robinson and the assistant librarian, Miss Hilda Moore, attended this
meeting.
MERCY HOSPITAL
New Medical Statistician
On April 16, Mr. L. Omer Huesman came to Mercy Hospital as Statistician in
charge of the Statistical Department. A graduate of Calvert Hall High School,
class of 1926, Mr. Huesman has been active in the field of medical statistics and for
the past 14 years has been Supervisor of the Statistical Department at the Johns
Hopkins Hospital.
Armed Forces Section
Dr. Joseph C. Sheehan, class of 1941, of the Obstetrical Visiting staff of Mercy
Hospital, left March 15, 1951, for service as a Captain in the United States Army,
at Fort George G. Meade, Maryland.
WOMEN'S AUXILIARY OF MERCY HOSPITAL ORGANIZED
On February 28, 1951, the first general meeting of the Women's Auxiliary of
Mercy Hospital was held at the hospital. Sister Mary Veronica, R.S.M., Adminis-
trator, addressed the members and stressed the necessity of a Women's Auxiliary to
help raise funds and act as volunteer workers in the hospital.
Meetings will be held on the fourth Wednesday of each month at 11 A.M. in
Room 33 of the hospital. Sister Mary Frances Louise, R.S.M., will serve as moderator
of the group.
Mrs. Charles R. Goldsborough has been elected Chairman of a benefit which will
be held in the fall of 1951 at the Alcazar.
MEDICAL SCHOOL SECTION v
DEPARTMENT OF MEDICINE
Department of Clinical Pathology
Dr. Milton S. Sacks, Director of the Department, spoke on "The Biochemical
Defect in Pernicious Anemia: A Review of Recent Work with Comments on Oral
Therapy," at the Sinai Hospital, Baltimore, staff meeting on April 26, 1951. A
series of lectures entitled "Blood Groups and Blood Transfusions" were given by
Dr. Sacks at the Veterans' Hospital, Fort Howard, Maryland, during May and
June, 1951. Dr. Sacks has also contributed the section on "The Treatment of Ery-
throblastosis Fetalis" in the 1952 edition of Current Therapy, edited by Dr. Howard
F. Conn. An editorial written by Dr. Sacks entitled "Ion Exchange Resins" appeared
in the Annals of Internal Medicine in April, 1951.
Dr. Joseph Workman, Baltimore Rh Typing Laboratory Fellow in Medicine,
recently read a paper entitled "The Lupus Erythematosis Cell Phenomenon" at the
meeting of the Dermatology Section of the Baltimore City Medical Society.
Dr. Marie Andersch, Chief Biochemist of the Department of Clinical Pathology,
attended the Federation meetings in Cleveland, Ohio, on April 29, 1951, where she
read a paper entitled "Studies in Alkali Denaturation of Hemoglobin."
DEPARTMENT OF SURGERY
The Department of Surgery is fortunate in being able to extend its clinical teaching
programs so that Baltimore City, Mercy, Kernan, and University Hospitals are
intimately involved in the subdepartments of Orthopedics, Genito-Urinary and
Neurosurgery. Certification by the respective boards covering training in these
departments has been obtained.
Dr. Russell S. Fisher, Associate Professor of Legal Medicine at the School of
Medicine and Chief Medical Examiner of Maryland, has recently been awarded a
United States Public Health Service Grant for research in unexpected death in
infancy and for continued study of the human cervix for carcinoma.
UNIVERSITY OF MARYLAND BIOLOGICAL SOCIETY
At the Program Meeting held on March 14, 1951, Dr. Gordon E. Gibbs, Associate
professor of Clinical Research of the Department of Pediatrics, presented a paper
entitled "The Effect of Pressure within the Pancreatic Ducts upon Pancreatic
Histology and Serum Amylase", an abstract of which follows.
The Effect of Pressure Within the Pancreatic Ducts Upon Pancreatic
Histology and Serum Amylase
Ligation of all pancreatic ducts in 3 dogs was followed during 24 hours by a gradual rise in serum
amylase to a value 2.8 times the initial level. Edema and slight leukocytic infiltration of the capsule
and interlobular septa of the pancreas were present at the end of this period. In 5 other dogs, the pan-
creas was subjected to a pressure of 30 cm. water within the duct system by means of a reservoir of
sterile saline. Serum amylase rose approximately twice as fast, and most dogs failed to survive the
vi BULLETIN OF THE SCHOOL OF MEDICI XE, U. OF MD.
full 24 hours. The pancreatic changes were edema, a greater degree of inflammatory reaction (in-
cluding acinar areas), slight hemorrhage, and small areas of acinar cell degeneration. Some fluid rich
in enzymes filtered through the surface of the pancreas and collected in the peritoneal cavity. That
this fluid probably accounted for part of the amylase that appeared in the serum was indicated by the
fact that a rise of serum amylase followed injection of pancreatic juice intraperitoneally in two other
dogs. One of these had been depancreatized and maintained with insulin. The other showed no histo-
logic evidence of damage to the pancreas.
POST GRADUATE COMMITTEE SECTION
POST GRADUATE COMMITTEE, SCHOOL OF MEDICINE
Howard M. Bubert, M.D., Chairman and Director
Elizabeth Carroll,
Executive Secretary
Post Graduate Office: Room 600
29 South Greene Street
Baltimore 1, Maryland
Extramural Courses
The demand for post graduate instruction has grown at an ever increasing tempo.
Two major factors have contributed to this: first, an aroused interest and desire
upon the part of many physicians for such instruction and, secondly, the dramatic
discoveries of the recent past that have rendered obsolete many of the therapeutic
and diagnostic mainstays of previous years.
Superficial consideration might seem to indicate that the problem of satisfying
these needs was a relatively simple one, but this, for various reasons, is far from true.
Chief among these are the apathy exhibited by many of those men most in need of
instruction and the crushing burden of work borne by most busy physicians.
In an effort to overcome the obstacles encountered, the Committee has endeavored
with, we believe, some measure of success to evolve new techniques. Not the least
of these has been the establishment of extramural courses in which the teaching is
done at points selected because of their proximity to the participating physicians'
zone of operations. It seemed better to take the few to the many rather than the
many to the few.
Certain of the county medical societies have acted as sponsors for these programs
and have made all local arrangements while the Post Graduate Committee has as-
sumed responsibility for providing competent instructors.
Those men interested in taking part in this activity might well communicate with
the president or secretary of their society or directly with the Post Graduate Com-
mittee Office. If sufficient interest is evidenced in a given area, such a course could
be arranged with little difficulty.
It is our ardent wish that this important phase of our work will grow and that
extramural courses will become an established custom in an increasing number of
counties throughout the state.
Pediatric Residency
Decentralization of pediatric graduate training has been carried on successfully
in many parts of the country. In September, 1948, the Pediatric Department of the
University of Maryland Hospital began a resident affiliation plan with the Penin-
sula General Hospital in Salisbury, Maryland. Initially, the period of rotation was
viii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
three months, but it has now been extended to four. Assistant residents who have
had some training in pediatrics, when assigned to Peninsula General Hospital, act
in the capacity of resident, supervising the care of patients admitted to the pediatric
service as well as providing supervision for the well baby nursery. In addition to their
hospital duties, they conduct the well baby and pre-school clinics for the Maryland
State Department of Health and work with some of the other local civic organiza-
tions who are interested in child health.
Immediate hospital supervision is provided by the local pediatrician in charge of
the service while periodic visits are made at six-week intervals by a staff member of
the Pediatric Department of the University Hospital. In the experience of the Pedi-
atric Department with this type of program, it has been concluded that it is of con-
siderable value to the participating assistant resident, primarily, in that he becomes
familiar with pediatric practice in a smaller community. Also, he is faced with re-
sponsibility and forced to make use of his diagnostic training, thus, discouraging
dependency upon expensive and often needless laboratory measures. Experience with
the local health units is a broadening one in that it has tended to provide men in
training with a knowledge of the relationship of the practicing pediatrician to the
local health effort.
The advantages of the program are not, however, all on the side of the University.
The value of the local hospital is increased in the eyes of the community by its asso-
ciation with a medical center. At the same time, the presence of residents acts as an
educational stimulus for the local physicians, and the community is made more at-
tractive to pediatricians who are contemplating practicing in that area.
When the affiliation was begun, there was only one pediatrician in the community
eligible to take the Pediatric Board examination. There are now three pediatricians
practicing in the community — one having been certified and the other two, eligible
to take the examination. Affiliations of this type should be utilized as a vital part of
the post graduate instruction. They offer opportunities of on-the-spot instruction for
local physicians and, through this means, it is possible for us to offer broader vistas
of pediatric knowledge to the practicing physicians of the community with resulting,
improved pediatric care for the patients.
It is the hope of the Pediatric Department of the University of Maryland School
of Medicine that this affiliation will be continued, strengthened, and enlarged and
that similar affiliations eventually can be carried out with other hospitals in the
State of Maryland.
Thoracic Surgery Residency
The Post Graduate Committee is happy to announce that Dr. Otto C. Brantigan
has succeeded in initiating a plan for the training of thoracic surgeons. The first year
of resident training is spent at the University of Maryland in research, and the second
year, as thoracic surgeon at University, Mercy, and City Hospitals. Upon comple-
tion of these two years, he will then be eligible for examination by the American
Board of Surgery and The American Board of Thoracic Surgery. We take pride in
the completion of another step forward in this field.
POST GRADUATE COMMITTEE SECTION ix
Orthopedic Residency
It is with great pleasure that the Post Graduate Committee calls attention to the
approval of the three-year resident training service program in orthopedic surgery,
described in previous issues of the BULLETIN, by the American Medical Asso-
ciation.
Maryland Academy of General Practice
Because of the interest evidenced by members of the Maryland Academy of Gen-
eral Practice in the seminar sponsored by their society in December, 1950, Dr.
Lauriston L. Keown, in cooperation with the Post Graduate Committee, arranged
a similar day of lectures which were presented on May 24, 1951. The following pro-
gram was presented, the material of which, we believe, is varied and timely. These
sessions were held in the Gordon Wilson Amphitheater of the University Hospital.
10:00-10:50 Chest Diseases
11:00-11:50 Melena
12:00-12:50 Acute Nephritis
1:00- 1:50 Cardiac Emergencies
1:50- 2:50 Luncheon
3:00- 3:35 ACTH and Cortisone in Re-
lation to Arthritis and
Allied Conditions
3:40-4:15 ACTH and Cortisone in Re-
lation to Acute Rheu-
matic Fever
4 : 1 5- 4 : 50 ACTH and Cortisone in Re-
lation to Allergic Condi-
tions
Otto C. Brantigan, B.S., M.D. Professor
of Surgical Anatomy, Professor of Clin-
ical Surgery, University of Maryland
Harry C. Hull, M.D., Professor of Clinical
Surgery, University of Maryland
Milton S. Sacks, M.D., Head of Clinical
Pathology, Associate in Pathology, As-
sociate Prof, of Medicine, University of
Maryland
William S. Love, Jr., A.B., M.D., Asso-
ciate Prof, of Medicine, University of
Maryland
T. Nelson Carey, M.D., Professor of Clin-
ical Medicine, University of Maryland
J. Edmund Bradley, M.D., Professor of
Pediatrics, Head of Dept. of Pediatrics,
University of Maryland
Howard M. Bubert, M.D., Associate
Prof, of Medicine, Chief, Section of Al-
lergy, University of Maryland
Members of the Maryland Academy of General Practice were guests of the Post
Graduate Committee at a luncheon served in the Hospital dining room at which
Dr. H. Boyd Wylie, Dean of the University of Maryland School of Medicine, greeted
those present.
In December, 1950, 64 physicians attended these lectures, representing the fol-
lowing counties in Maryland: Allegany, Baltimore, Caroline, Carroll, Frederick,
Garrett, Harford, Prince Georges, Talbot, Washington, and Worcester.
Officers of the Maryland Academy of General Practice are: Dr. Charles F. O'Don-
nell, Towson, Maryland, president; Dr. Irving Baumgartner, Oakland, Maryland,
secretary-treasurer; and Drs. E. Paul Knotts, Nathan Needle, and B. B. Kneisley,
vice-presidents.
ALUMNI ASSOCIATION SECTION
OFFICERS
Lours A. M. Krause, M.D., President
Vice-Presidents
Samuel E. Enfield, M.D. Randolph M. Nock. M.D.
Thurston R. Adams, M.D., Secretary Simon B
Minette E. Scott, Executive Secretary Charles
Board of Directors Hospital Council
William H. Triplett, M.D. Alfred T. Gundry, M.D.
Chairman
Louis A. M. Krause, M.D.
Charles Reid Edwards, M.D.
Thurston R. Adams, M.D.
Simon Brager, M.D.
Austin Wood, M.D.
Wetherbee Fort, M.D.
Albert E. Goldstein, M.D.
Daniel J. Pessagno, M.D.
Louis H. Douglass, M.D.
George F. Sargent, M.D.
Nominating Committee
Frank Ogden, M.D.
Chairman
Robert F. Healy, M.D.
Ernest I. Cornbrooks, M.D.
Frank K. Morris, M.D.
David Tenner, M.D.
Alumni Council
Fred B. Smith, M.D.
rager, M.D., Assistant Secretary
Reid Edwards, M.D., Treasurer
Library Committee
Milton S. Sacks, M.D.
Representatives to General Alumni
Board
John A. Wagner, M.D.
Thurston R. Adams, M.D.
William H. Triplett, M.D.
Representatives, Editorial Board,
Bulletin
Harry C. Hull, M.D.
Albert E. Goldstein, M.D.
Louis A. M. Krause, M.D.
(ex-officio)
Lewis P. Gundry, M.D.
The names listed above are officers for the term beginning July 1, 1950 and ending June 30, 1951.
A LETTER TO THE CLASS OF 1951
FROM THE MEDICAL ALUMNI ASSOCIATION
The diploma which now hangs on your wall is certainly an acknowledgment of a
long cherished ambition and a recognition of your perseverance and ability as wit-
nessed by the Faculty of Medicine which has seen fit to bestow it upon you. You
are no doubt quite proud in your new office and most certainly do you covet the
enviable, professional status which has been your just reward.
We, of the Alumni Association, do congratulate you upon your achievement and
extend a welcoming hand of friendship as you become one of the several thousand
living alumni of the School of Medicine. Your days as an undergraduate medical
student are now at an end. As a physician and an alumnus, you have entered the
second sphere of the practice of medicine and upon your shoulders now rest obliga-
tions which far exceed those which you have considered heretofore as being weighty.
You will have obligations to family, to your patients, and to the community in
which you reside; for indeed, the profession which is yours to enjoy is an honorable
one and must be defended by what you know as ethics, by community leadership
and by exemplary behavior. In the Hippocratic Oath to which you have now sub-
scribed, there is an explicit statement concerning your obligation to enlarge and
perpetuate the medical training of those who would follow in your footsteps. The
implementation of this, your subscribed promise, no doubt at this moment seems
vague. No doubt you consider it wise to maintain an active interest in medical
education, for as a student you have at times voiced both criticism and praise of
educational methods as they applied to you. You were perhaps impressed and
ALUM XI ASSOCIATION SECTION xi
sometimes depressed at the physical surroundings; the adequacy or inadequacy they
presented in the furtherance of your educational desires. These physical surroundings
and their facilities resulted from the work and attention of men who were your
predecessors in medicine. As you now become an alumnus, the continuation of such
facilities and their improvement becomes an increasing part of your obligation.
At Commencement, the class of 1951, as a unit, became dismembered. You will
no longer attend classes together, and there will be no more class dances. However,
the unity of your class is now maintained through the unity of your Alumni Asso-
ciation. What advances you as an individual can make in the perpetuation of the
good name of your Alma Mater rests not alone in your personal achievements but
through your activities in the Alumni Association whose sole purpose is the advance-
ment and the guardianship of the traditions of the school from which you have
drawn so bountifully. The Alumni Association is not a social group nor is it a political
venture. It is not a subsidiary of the faculty nor a branch of the Dean's office. It is
an autonomous organization of all alumni through which their interest and activities
can be focused toward a common goal: a better school of medicine.
Your Alumni Association has voted you a free membership for the year 1951-52
and at the same time has purchased for you a subscription to the official Alumni-
Faculty journal, the Bulletin. We feel that our desire to have you as an interested
alumnus and to have you grow into the Association is expressed not only by our
overt gestures but by an abiding faith in your interest to the effect that it shall
continue unbroken through the many years that lie ahead.
Congratulations to you all.
William D. Triplett, M.D.
Chairman, Board of Directors
Correction
In the Bulletin (36: Alumni Section, p. xxi, January, 1951) it was stated
that Dr. Wilbur S. Brooks, class of 1938, was Chief Radiologist at the Univer-
sity of Syracuse, Syracuse, New York. Dr. Brooks is attending radiologist at the
General Hospital of Syracuse.
The Bulletin sincerely regrets the error.
ITEMS
Dr. Hiram P. Upton, class of 1927, of Burlington, Vermont, has been appointed a
member of the Vermont State Health Commission. Dr. Upton has recently served
as president of the Vermont State Medical Society.
Dr. Charles A. Neafie, class of 1909, of Pontiac, Michigan, was recently elected a
founder member of the American Board of Preventive Medicine and Public Health.
He has been identified with public health administration in Pontiac since 1917, re-
ceiving the degree of Master of Science in Public Health from the University of
Michigan in 1924.
Dr. Otto C. Brantigan presented a paper entitled "Thoracoplasty in the Treat-
ment of Pulmonary Tuberculosis" at the April, 1951 meeting of the Southeastern
Surgical Conference.
xii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Dr. John C. Ozazewski, class of 1943, and until recently Resident in Ophthal-
mology at the University Hospital, will be associated with Dr. Frank Walsh in the
practice of Neuro-ophthalmology.
Dr. George W. Smith of the Department of Neurosurgery has recently been elected
a member of the American Association of Electroencephalographers.
Dr. John H. Shaw, class of 1947, until recently Resident in Medicine at the St.
Agnes Hospital, Baltimore, has recently opened his office for the practice of Internal
Medicine at 701 Charing Cross Road, Baltimore.
Dr. Arthur T. Hall, class of 1945, who completed his Residency in Surgery at the
St. Agnes Hospital in Baltimore on July 1st, has opened his office at 7 East Mt.
Royal Avenue in Baltimore where he will begin practice of General Surgery.
Dr. Robert M. N. Crosby, class of 1943, who completed his Residency in Neuro-
surgery at the School of Medicine on July 1, 1951, has been appointed to the Faculty
of the University of Chicago School of Medicine. Dr. Crosby will devote his practice
to Pediatric Neurology under the preceptorship of Dr. Douglass Buchanan.
With the completion of his Residency year in Obstetrics on June 30, 1951, Dr.
William C. Covey, Jr. plans to enter private practice in his home town of Beckley,
West Virginia.
Dr. Frank J. Ayd, Jr., class of 1945, recently lectured at the 19th Annual Con-
vention of the National Conference on Family Life which was held in St. Louis,
March 5-7, 1951. Dr. Ayd is currently on the faculty of the Catholic University in
Washington and is a member of the Department of Psychology at Loyola College
in Baltimore.
Dr. Frank J. Ayd, Jr., class of 1945, was guest lecturer at the University of Notre
Dame, South Bend, Indiana, on April 26, 1951, at a meeting held under the joint
auspices of the Department of Religion and the General Program of Liberal Edu-
cation. Dr. Ayd spoke on the subject of "Religion and Psychiatry."
Dr. William E. McGrath, class of 1943, who was called to active duty in the
United States Army in October, 1950, has been separated from the armed forces and
has returned to his practice at 3534 Edmondson Avenue, Baltimore.
Dr. Louis O. J. Manganiello, class of 1942, a former resident in Neurologic Surgery
at the University Hospital, has been appointed Chief of the Department of Neuro-
logic Surgery at the University of Georgia School of Medicine, Augusta, Georgia.
Dr. Robert A. Moses, class of 1942, has recently opened his offices at 110^ South
Third Street, Delevan, Wisconsin. Dr. Moses will limit his practice to ophthalmology.
Dr. J. Morris Reese, class of 1920, Associate Professor of Obstetrics, has been
appointed Councilor of the Southern Medical Association for a five year period begin-
ning in the Fall of 1951. Dr. Reese will succeed Dr. F. A. Holden, also of the class of
1920, who has served for a number of years on the Council of the Southern Medical
Association.
Dr. Frank Concilus, class of 1942, for the past two years has resided at 470 Summit
Drive in Pittsburgh where he^has been engaged in the practice of Internal Medicine.
ALUMNI ASSOCIATION SECTION xiii
Dr. Edward Siegel, class of 1938, has served as co-author with Dr. Conrad Berens,
of a new textbook entitled Encyclopedia of the Eye.
Dr. Siegel currently practices ophthalmology in Plattsburg, New York.
Dr. Melvin B. Davis, class of 1931, was recently elected President of the Baltimore
County Medical Society.
Dr. Thomas P. Murdock of Meriden, Connecticut who is currently serving as a
member of the Board of Trustees of the American Medical Association was honored
at a testimonial dinner at New Haven, Connecticut on November 29, 1950. Dr. Mur-
dock is a graduate of the Baltimore Medical College, class of 1910.
Dr. Fred R. McCrumb, class of 1948, has been appointed Fellow in Medicine at
Rockefeller Institute in New York where he will continue his studies in infectious
diseases.
The Mayo Clinic announces the following appointments from the Class of 1950:
Dr. Louis G. Chelton, has been appointed Fellow in Medicine, Dr. John L. Bacon,
Fellow in Pediatrics and Dr. Stanley W. Henson, Jr., Fellow in Surgery effective
July 1, 1951.
These three Alumni are currently serving their internships at the United States
Marine Hospital in Baltimore before proceeding to the Mayo Clinic.
CORRESPONDEN CE
December 11, 1950.
Thanks very much for your interesting letter of November 20, giving me Dr.
Rowland's address and giving me data, etc. about the Reunion, June 7th, 1951.
Just celebrated my 77th birthday and am looking forward to being present and
receiving my 50 year certificate. I will try to get Dr. H. E. Anthony of Moravia,
New York, to join me. He is a member of my class.
I am going to write Dr. Rowland today. We all thought a great deal of him as a
teacher and a friend.
Hoping to see you in June and wishing you the compliments of the season, I am
Fraternally yours,
M.D. Lipes, Class of 1901, B.M.C.
1440 Broadway
Watervliet, New York
February 11, 1951.
I am cleaning house but hesitate to throw away my Bulletins before learning if
you have any use for them. If you have, I will be glad to take them over to the
library the next time I go to Baltimore.
Very truly yours,
H. B. McDonnell, class of 1888, P & S
7400 Dartmouth Avenue
College Park, Maryland
(Ed. Note: The Medical Library is ahvays grateful for such valuable contributions.)
xiv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
December 11, 1950
Please accept my thanks for the beautiful fifty year certificate issued by the
Alumni Association which was presented to me in person June 9th. I also apologize
for the delay in doing so.
Very sincerely yours,
G. Allen Troxell, class of 1900, B.M.C.
1622 Charlotte Street
Sarasota, Florida.
February 9, 1951
I wish to thank the Medical Alumni Association for placing my picture in the
October number of our Bulletin of the School of Medicine. My son and I are deeply
appreciative of the fine compliment.
.... The likenesses (of all — Ed.) are good and faithful, and you all look happy.
The slightest turn of the mind takes me back in memory to my beloved Library
in Davidge Hall, within whose walls I worked happily for over thirty- two years
and laid the foundations of many precious friendships. You were all marvelous to
me, and I owe you an eternal debt of gratitude. I was happy in my library work, and
I am happy in my leisure. I have nothing left to wish for. I feel as though I have
"warmed my hands at the fire of life". God bless you all!
With deep affection from your devoted librarian and friend,
Ruth Lee Briscoe, Librarian Emeritus
OBITUARIES
IBv. glfaertu* Cotton
Dr. Albertus Cotton, professor emeritus of orthopedic surgery and roentgenology
at the University of Maryland School of Medicine, died May 3, 1951, after an illness
of several weeks.
Dr. Cotton was born in Marysville, Kansas, on September 23, 1872. He attended
Ohio University and received the M.A. degree there in 1891, after which he came to
Baltimore and entered the College of Physicians and Surgeons where he was gradu-
ated with honors in 1896. After graduation he served his internship at City Hospital
(now Mercy Hospital) from 1896 to 1898.
A pioneer in the study of roentgenology, an orthopedic surgeon and an educator
for almost half a century, Dr. Cotton was active in his profession until declining
health forced his retirement several years ago.
In 1906 Dr. Cotton went abroad, studying in Berlin and Vienna and returning to
begin his long association with the University of Maryland School of Medicine.
Until the time of his retirement, he was professor of roentgenology and orthopedic
surgery at the University of Maryland, attending orthopedic surgeon at Mercy
Hospital, and visiting orthopedic surgeon at Kernan's Hospital for Crippled Chil-
DR. ALBERTUS COTTON
XV
xvi BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
dren. He conducted orthopedic clinics for crippled children at Snow Hill and Salis-
bury, Maryland for 15 years.
Dr. Cotton was a member of numerous medical societies and the author of numer-
ous papers on orthopedic surgery and roentgenology.
His wife, the former Florence Brown of Baltimore survives.
Br. Jfrancts Jfl. Jfflatulattts (lait)
Dr. Francis M. Lait, class of 1907, Baltimore Medical College, died at his home
at 7829 Euclid Avenue, Cleveland, Ohio, on January 31, 1951.
Born in Lithuania in 1876, he came to this country in 1902 and entered the Balti-
more Medical College the following year. After his graduation, he settled in Boston,
Massachusetts where he practiced until 1919. After a period of post-graduate train-
ing, he moved to Cleveland, Ohio, where he practiced ophthalmology from 1933
until his death.
Br. lUagfjmgton Hec Jfflacfe
Dr. Washington Lee Mack, class of 1892, College of Physicians and Surgeons, of
Walla Walla, Washington, died on September 17, 1949, aged 81, of coronary throm-
bosis.
Dr. Mack practiced at Cordova, South Carolina, for over 55 years and was retired
but a short time prior to his death.
Br. Ctjarles 8. &nox
Dr. Charles A. Knox, class of 1904, B.M.C., died on March 9, 1951, at the Hacken-
sack Hospital, Hackensack, New Jersey, aged 72.
Dr. Knox was a former president of the Ridgefield Park Trust Company and was
a member of the staffs of both the Hackensack Hospital and the Holy Name Hos-
pital in Teaneck, New Jersey.
Br. Jfratufe 1L. $aglt
Dr. Francis L. Bagli, class of 1921, died at his home in Baltimore on March 12,
1951, aged 54.
A native of Italy, Dr. Bagli came to this country at the age of 2 and spent his
childhood in Paterson, New Jersey. In 1921 he was graduated from the School of
Medicine, serving his internship at Baltimore City Hospitals. After a short period
of general practice, he specialized in obstetrics. He was a member of the staffs of
St. Agnes, Maryland General, and Bon Secours Hospitals. Aside from his medical
accomplishments, Dr. Bagli was a talented musician.
DR. FRANKLIN B. ANDERSON
Dr. Franklin B. Anderson passed away very suddenly at his home, 8419 Loch
Raven Boulevard, Baltimore, Maryland, on Tuesday, January 23, 1951.
Dr. Anderson was born on August 31, 1886, at Monkton, Maryland, the only
son of Charles W. and Ozello B. Anderson. His early education was obtained in
the Baltimore County Schools and his high school training at the Baltimore Poly-
technic Institute. He entered the University of Maryland School of Medicine in
1912, and was awarded his M.I), degree in 1916.
OBITUARIES xvii
Soon after graduation, Dr. Anderson became interested in diseases of the Eye,
Ear, Nose and Throat and practiced this specialty until his death. He was an active
and interested teacher in the School of Medicine, beginning as an Assistant in
Otolaryngology, being promoted to Associate, Assistant Professor, and then to
Associate Professor of Otolaryngology, which title he held at the time of his death.
Dr. Anderson was a member of the Staff of the University Hospital and Consulting
Aurist and Laryngologist for the Kernan Hospital, Baltimore. For years he had
been in charge of Otolaryngology at the Maryland House of Correction.
Dr. Franklin Anderson had a distinguished career in the Military Service of his
country. He was commissioned a First Lieutenant in the Medical Corps June 29,
1916, and was called to service January 6, 1917, during the Mexican Border Inci-
dent. During World War I he was promoted to Captain and commanded the 113
Ambulance Company of the Centre Section in France at Haute Alsace, Meuse, and
Argonne. He was honorably discharged on June 23, 1919, after serving overseas
from July 5, 1918 to May 22, 1919. Returning to Maryland, he continued his Army
Service with the Maryland National Guard, holding successively the ranks of
Major, Lieutenant Colonel, and Colonel, retiring January 31, 1940, as Brevet
Colonel.
DR. FRANKLIN B. ANDERSON
xviii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
On December 2, 1916, he married Miss Wilma M. Schmitt. A daughter and only
child, Phyllis, was born on May 2, 1922. Phyllis is now a Medical Artist employed
at the Walter Reed Hospital in Washington, D. C.
As a kind, considerate physician loved by his patients and friends, he will be
greatly missed by all who knew him.
Edward A. Looper, M.D.
DR. JOHN GIRD WOOD
Dr. John Girdwood, class of 1894, Medical Examiner for the City Service Com-
mission for many years, died on September 25, 1950, at Baltimore, Maryland,
aged 79.
Born in the Barbados, West Indies, he came to Baltimore as a child. Following
his graduation from the School of Medicine, he served in the Federal Government
and was then appointed examining physician for the city, being the first physician
appointed in connection with the administration of the local Merit System.
DR. WILLIAM C. LOWE
Dr. William C. Lowe, class of 1941, died at the University Hospital on February
4, 1951, of injuries received in an automobile accident.
Dr. Lowe, 33, who was engaged in practice near Centreville, Maryland, was a
native of Stevensville, Maryland. He served his rotating internship at Mercy Hos-
pital, Baltimore, from where he entered the Army, serving as a Captain in the
Medical Corps from 1944 to 1946.
DR. GIDEON TIMBERLAKE
Dr. Gideon Timber lake, formerly Professor of Urology at the School of Medicine
and a founder of the American Board of Urology, died at St. Petersburg, Florida
on March 1, 1951.
A graduate of the University of Virginia, Dr. Timberlake was active for many
years in Baltimore, serving on the staffs of St. Agnes and Franklin Square Hospitals
and the Church Home and Hospital.
DR. WILLIAM GWYNN QUEEN
Dr. William Gwynn Queen, class of 1908, aged 67, died at his home in Baltimore
on January 3, 1951, of a heart attack.
Dr. Queen was born in Bryanttown, Charles County and was a graduate of Rock
Hill College in ElUcott City.
Following his graduation in the School of Medicine, he interned at the University
Hospital, later limiting his practice to pediatrics, becoming Pediatrician-in-Chief
at Bon Secours Hospital with membership on the staffs of Mercy, St. Agnes and
St. Joseph's Hospitals, Baltimore.
He is survived by his wife, two daughters and a son. Dr. J. Emmett Queen of the
class of 1943.
OBITUARIES
DR. WILLIAM GWYNN QUEEN
DR. MOSES LICHTENBERG
Dr. Moses Lichtenberg, class of 1912, died on December 26, 1950. He was born
in Baltimore, graduated from the Baltimore City College, and obtained his medical
degree from the School of Medicine, University of Maryland.
In World War I Dr. Lichtenberg was a member of the Medical Corps of the
United States Army. During his long Career he was constantly associated with
the activities of the Athletic Department of the Baltimore City College serving
for many years as team physician, an appointment through which he was rewarded
only by the satisfaction of assistance to the youth of Baltimore.
From 1930 until his retirement in 1948 it is said that he rarely, if ever, missed
a game, being constantly with the City College athletic teams. At the close of the
1948 season he was awarded a rising ovation and a Varsity letter by the student
body of the City College.
DR. JAMES HERBERT WILKERSON
Dr. James Herbert Wilkerson, class of 1921 and former Associate Professor at
the School of Dentistry, died in Baltimore on December 22, 1950 aged 53. He had
been in poor health following a heart attack three years ago.
xx BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Abramovitz, Morris, Baltimore, Md.; B.M.C., class of 1906; aged 71; died, Febru-
ary 7, 1951, of cerebral hemorrhage.
Carpenter, Eugene H., Oneida, N. Y.; P & S, class of 1894; aged 81; died, Novem-
ber 21, 1950, of chronic myocarditis.
Culverhouse, John Burnett, Baltimore, Md.; class of 1914; aged 59; died, recently,
of acute coronary occlusion and hypertension.
Driscoll, William Thomas, Norwich, Conn.; P & S,»class of 1912; aged 64; died, re-
cently, of coronary thrombosis.
Esker, Harry Hood, Clarksburg, W. Va.; P & S, class of 1906; aged 66; served during
World War I; died, January 23, 1951, of heart disease.
Gallion, William Edwin, Jr., Darlington, Md.; class of 1912; aged 64; died, recently,
of coronary thrombosis.
Gardiner, William Robert, Herrin, 111.; class of 1910; aged 65; died, February 13,
1951, of cerebral hemorrhage.
Gott, Ernest Fred, Charleston, W. Va.; P & S, class of 1915; aged 63; served during
World War I; died, December 31, 1950, of heart disease.
Gurley, Hubert Taylor, Baltimore, Md.; class of 1925; aged 51; died, recently, of
coronary thrombosis, arteriosclerosis and diabetes mellitus.
Hartshorne, George Ewing, Tulsa, Oklahoma; class of 1893; aged 83; served during
World War I; died, January 19, 1951, of arteriosclerotic heart disease.
Kelley, James Turner, Rixeyville, Va.; B.M.C., class of 1893; aged 86; died, Decem-
ber 22, 1950, of congestive heart disease.
Hess, James Mercer, Tylersburg, Pa.; P & S, class of 1905; aged 67; served during
World War I; died, January 21, 1951, of myocarditis.
Kafer, Oswald Ottmar, Edward, N. C; class of 1905; aged 70; died, January 28, 1951,
of coronary thrombosis.
Mace, Charles Herbert, West Springfield, Mass.; B.M.C., class of 1900; aged 79;
died, December 10, 1950, of arteriosclerosis.
Matthews, Alva Adair, Oak Hall, Va.; class of 1910; aged 66; died, December 31,
1950, of cerebral hemorrhage and arteriosclerosis.
Milliken, Walter S., Madison, Me.; B.M.C., class of 1897; aged 80; died, November
20, 1950, of cardiovascular disease. .
Missildine, John Gurley, Wichita, Kansas; class of 1911; aged 66; served during
World War I; died, January 30, 1951, of coronary thrombosis.
Robertson, Wilburn Burdett, Burnsville, N. C; B.M.C., class of 1898; aged 76;
died, January 6, 1951, of carcinoma.
Roop, William P., Absecon, N. J.; class of 1907; aged 71; died, December 27, 1950,
of cerebral hemorrhage.
Ross, Samuel Boyd, Philadelphia, Pa.; B.M.C., class of 1912; aged 69; served during
World War I; died, October 25, 1950, of chronic myocarditis.
Saul, Henry Wilson, Kutztown, Pa.; B.M.C., class of 1894; aged 81; died, February
12, 1951, of carcinoma of the pancreas.
Schneider, Charles Augustus, Newark, N. J.; B.M.C., class of 1900; aged 74; died,
February 2, 1951, of lymphoblastoma.
OBITUARIES xxi
Stuart, LeClare, Rome, N. Y.; P & S, class of 1908; served during World War I;
aged 67; died, December 22, 1950, of injuries received in an automobile acci-
dent.
Swank, Peter L., Boalsburg, Pa.; P & S, class of 1889; aged 88; died, December 5,
1950, of carcinoma of the rectum.
Tumbleson, Charles Cumming, Sandy Spring, Md.; P & S, class of 1905; aged 72;
died, November 30, 1950, of carcinoma of the kidney.
Tweedie, Hedley Vicars, Rockland, Me.; B.M.C., class of 1897; served during World
War I; aged 84; died, December 6, 1950, of carcinoma of the colon.
Walsh, John Edward, Revere, Mass.; B.M.C., class of 1898; aged 77; died, Novem-
ber 8, 1950, of heart disease.
Wilkerson, James Herbert, Baltimore, Md.; class of 1921; aged 53; died, December
22, 1950, of heart disease.
Williams, James Owen, Alderson, W. Va.; P & S, class of 1914; aged 67; died, De-
cember 4, 1950, of cerebral hemorrhage.
Aptaker, Albert J., Forest Hills, N. Y.; class of 1927; aged 47; died, October 19, 1950,
of coronary occlusion.
Devlin, Hugh Joseph, Newark, N. J.; B.M.C., class of 1905; aged 77; died, October
24, 1950.
Dobson, James Furman, Ridgeway, S. C. ; class of 1914; aged 59; served during World
War I; died, September 22, 1950, of cancer.
Douthirt, Cranford H., Santa Fe, New Mexico; class of 1914; died, December 1,
1950, of coronary occlusion.
Foster, Ruth, New York, N. Y.; class of 1931; aged 56; died, September 29, 1950, of
carcinoma.
Galligan, Edward Joseph, Taunton, Mass.; P & S, class of 1896; aged 81; died, Sep-
tember 25, 1950, of arteriosclerotic heart disease.
Halliday, Charles H., Baltimore, Md.; P & S, class of 1904; aged 70; died, September
30, 1950, following a gallbladder operation.
Hershner, Newton W., Mechanicsburg, Pa.; class of 1906; aged 72; died, October 8,
1950, of coronary occlusion.
Jaffe, Benjamin Meyer, Baltimore, Md.; class of 1916; aged 55; died, recently.
MacConnell, John Wilson, Davidson, N. C; class of 1907; aged 72; served during
World War I; died, September 26, 1950, of carcinoma.
Stevens, Thomas H., San Diego, Calif.; B.M.C., class of 1893; aged 89; died, October
17, 1950, of carcinoma of the colon.
Walsh, John E., of Revere, Massachusetts, B.M.C., class of 1898, died on Novem-
ber 8, 1950, at the age of 78.
FRATERNAL NEWS SECTION
ALPHA OMEGA ALPHA
During the past six months the Beta Chapter of the Alpha Omega
Alpha Honorary Medical Society has enjoyed an active and productive
period in the extra-curricular events of the School of Medicine. An
annual fall banquet took place on December 8, 1950. Dean H. Boyd
Wylie, a member of Beta Chapter was the speaker of the evening.
His topic was entitled "Medical Education and Its Problems."
Three business meetings were held during the month of March,
1951, at which time, policies of the Society were studied; and activi-
ties which may benefit the University at large were discussed.
A series of 3 lectures, dealing with the doctor and society was sponsored by the
Society. These open lectures were given in the Gordon Wilson Hall, University Hos-
pital, at 5 P. M. The lectures and their respective dates are listed:
Dr. Maurice C. Pincoffs, Professor of Medicine; Medical Ethics; Mar. 27, 1951.
Dr. John C. Krantz, Professor of Pharmacology and Head of the Department;
The Doctor and the Population; Apr. 3, 1951.
Dr. Jacob E. Finesinger, Professor of Psychiatry and Head of the Department;
Recent Trends in Medical Education; Apr. 10, 1951.
On May 2, 1951, Beta Chapter held its second annual Spring Banquet. At the
meeting, three senior students, Messrs. J. H. Stone, Charles P. Watson, Jr., and Rob-
ert D. Weekley were initiated. Also 5 junior students were initiated. These included
Messrs. Charles B. Adams, Richard E. Ahlquist, Daniel Clyman, William Mathews
and Alvin Stambler. The following alumni were also initiated as members of this
Chapter: Dr. William Long, class of 1937, and at present a practicing surgeon in
Salisbury, Maryland, and Dr. J. Hornbaker, class of 1930, a practicing internist at
Hagerstown, Maryland.
The newly appointed officers for the coming year were announced:
President: William Mathews
Vice-President : Alvin Stambler
Assistant Secretary: Daniel Clyman
The offices to be continued are Counselor: Dr. John E. Savage; and Secretary-
Treasurer: Dr. Milton S. Sacks. The evening was made memorable because of a
most stimulating and instructive lecture given by Dr. William Dameshek, Professor
of Clinical Medicine, Tufts College Medical School. The title of his talk was "The
Blood, The Spleen, and The Bone Marrow.,J The lecture was open to the medical
profession and was well attended. This lecture by Dr. Dameshek was the first of a
series of annual talks to be given by well known members of the profession and
sponsored by Beta Chapter. The chapter sincerely hopes that the lectures to follow
will realize the success of the initial experience.
In an attempt to stimulate the interest of both students and faculty in academic
fields in which students may participate, Beta Chapter terminated its school year
FRATERNAL NEWS SECTION xxiii
with a group of 6 papers delivered by senior students of the University of Maryland.
These papers represented extra-curricular work in the academic fields of medicine,
in which the speakers were privileged to participate. The detailed program follows.
Program of Student Research Papers
University of Maryland School of Medicine
Gordon Wilson Hall
May 16, 1951
Sponsored by Beta Chapter, Alpha Omega Alpha Society
1. Preliminary Study of Distribution of a Naturally Occurring Hemagglutinins in Human Sera,
David Kipnis; Discussion by Dr. Milton S. Sacks
2. Preliminary Study of Personalities of Medical Students by Use of Rorschach Test, Jack Leib-
man and Fred Johnson; Discussion by Dr. Jacob E. Finesinger
3. A Personality Stud}- of Junior High School Problem Children, Jack Liebman; Discussion by
Dr. Jacob E. Finesinger
4. Convulsant and Anticonvulsant Effects of Some Antihistaminic Drugs, William G. Esmond;
Discussion by Dr. Harold E. Himwich, Chief, Clinical Research Branch, Medical Research Division,
Army Chemical Center, Maryland
5. Cardiovascular Responses to Tilting and Standardized Exercise in Young and Old Males,
Charles Ferguson; Discussion by Dr. Dietrich Smith, Department of Physiology
6. An In- Vivo Antibiotic Protection Study Against Leptospirosis Icterohemorrhagica, Leonard
Lister; Discussion by Dr. T. E. Woodward
All junior and senior classes were suspended, and the student body and faculty
were invited. Dr. Milton Sacks acted as moderator. It is hoped by the Society that a
similar series of papers may be given annually.
PHI DELTA EPSILON
Recently the fraternity has had the pleasure of serving as
host to several distinguished lecturers. Dr. Louis Soffer, of
Columbia University School of Medicine, delivered the an-
nual Phi Delta Epsilon, guest lectureship at the School of
Medicine. His discussion of the physiology and clinical ap-
plications of ACTH was warmly received by a large audi-
ence. Dr. Helen Taussig and Dr. Emanuel Schoenbach, both
of Johns Hopkins, delivered lectures at the house during the
regular monthly scientific meetings. Dr. Taussig's lecture
concerned persistent truncus arteriosus, and Dr. Schoenbach
spoke on the selective use of antibiotics.
At recent elections, Alvin Stambler was elected consul to succeed David Kipnis.
Other officers chosen were: Joseph Schuman, vice-consul; Norman Miller, secretary;
Jonas Rappaport, treasurer; Leonard Glick, historian.
Three members of the fraternity deserve special mention. Alvin Stambler and
Daniel Clyman have become members of Alpha Omega Alpha honorary fraternity.
Israel Weiner has been awarded the Aaron Brown prize for the best scientific paper
submitted by a member of the national fraternity.
xxiv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
The graduate club of this city is now under the leadership of Dr. Louis Blum of
the Department of Medicine. At the last national convention in New York, Dr.
Samuel S. Glick of the Department of Pediatrics, was elected to the office of Vice-
Grand Consul; and Dr. I. A. Siegel of the Department of Obstetrics, was appointed
District Deputy Grand Consul to supervise chapters in this region.
Dr. David Silberman recently led a gynecology symposium at Johns Hopkins and
Sinai Hospitals. The symposium was sponsored by the Gynecology Club, composed of
fraternity members throughout the nation. A similar event takes place each year in a
major city.
In April Dr. Ephraim Lisansky of the Department of Medicine and Psychiatry,
delivered a lecture in Arlington, Virginia, entitled "Psychosomatics in Cardiovascular
Diseases."
Dr. Albert E. Goldstein, of the Department of Urology and Pathology, was a dis-
cussant of papers delivered in April before the Mid-Atlantic section of the American
Urological Association. He will also discuss papers in June at the national meetings
of the A.U.A. in Chicago, and of the A.M.A. in Atlantic City.
NU SIGMA NU
Dr. Jacob W. Bird, class of 1908, recently visited the
house and presented a large, framed picture of his class
to be hung on the wall.
The annual Spring Formal was held at the Stafford
Hotel on April 7, 1951, and was well attended.
All Alumni Brothers are invited to see the new and
valuable bookcase purchased for the house library.
On April 25, 1951, a smoker was held for pledges.
Among the Alumni attending were: Drs. T. Conrad
Wolff, 1917, Dr. Ernest I. Cornbrooks, Jr., 1935, Dr.
Edward F. Cotter, 1935, Dr. Karl F. Mech, 1935, and Dr. John A. Wagner, 1938.
The attending Alumni each gave a few valuable words to the new pledges.
phases of
PHI BETA PI
There will be twelve Phi Beta Pi members in this year's
graduating class. The last time a Phi Beta Pi graduated from the
School of Medicine was in 1940. In the years to come, this number
will become much larger.
The annual initiation ceremony was held in February, and 25
pledges were accepted as members of the fraternity. At the first
meeting after the initiation, a plan was inaugurated which called
for a dinner, business meeting, and seminar to be held on the first
Friday of every month. A guest speaker is invited to each of these
sessions so that the clinical aspect of important diseases might
be presented along with student speakers who cover various
the topics selected.
FRATERNAL NEWS SECTION xxv
In March, 1951, Dr. Emil Novak, a Phi Beta Pi, gave an interesting talk to fra-
ternity members and their guests. His topic was "Primary Dysmenorrhea". An
interesting question and answer discussion of this topic followed Dr. Novak's speech.
Fraternity officers are planning to hold similar meetings during the coming year.
A picnic was held on the last Sunday of April at Dr. Theodore Kardash's shore
home. Phi Beta Pi hopes to make this one of its big annual events.
The Chapter Library is progressing slowly, and we wish to thank those who have
made contributions. Alumni of Phi Beta Pi are solicited for contributions of books
and Journals. The mailing address is in care of the School of Medicine.
OF
THE SCHOOL OF MEDICINE
UNIVERSITY OF MARYLAND
volume 36 October j 1951 NUMBER 4
THE EFFECT OF CORTISONE IN THE TREATMENT OF
TYPHOID FEVER*f
THEODORE E. WOODWARD, M.D., JOSEPH E. SMADEL, M.D. and
ROBERT T. PARKER, M.D.
The control of infectious diseases has progressed markedly in the last few decades
as a result of the control of the microbial causes of disease. We are now entering an
era when emphasis is shifting from the microbial agent to the host.
The use of ACTH and cortisone in the collagen diseases and in those of endocrine
or hypersensitive origin is well known. Moreover, the momentous contributions of
Kendall, Hench, Thorn and Harvey pertaining to cortisone and ACTH have again
reemphasized the importance of the host factor. Indeed, Finland and his collaborators
observed that during the course of pneumococcal pneumonia the patient receiving
ACTH was rendered free of symptoms in spite of continued bacteremia. Our interests
have been directed toward typhoid fever.
Clinicians need hardly be reminded of the two mechanisms that damage typhoid
patients. These are: 1 — a septicemic disease with local lesions throughout the body
certain of which are prone to accidents, for example, hemorrhage and perforation of
the intestinal ulcer and: 2 — a severe toxemia which is more difficult to define but is
apparent to all clinicians. In 1926 Jaffe and Plaske noted that in the absence of
accessory cortical tissue adrenalectomized rats were highly susceptible to the toxic
effects of typhoid vaccine for as long as 5 months after the operation. They noted that
autoplastic cortical transplants protected adrenalectomized rats against the typhoid
toxin in amounts otherwise lethal. Subsequently the protective action of cortisone
against the shocking action of typhoid toxin in adrenalectomized rats was clearly
demonstrated by Lewis and Page.
Clinical investigators interested in chemotherapy of acute infectious diseases have
not been fully satisfied with the therapy of typhoid fever. Despite the obvious
benefits of chloramphenicol therapy in typhoid, there are several problems which
remain to be solved: 1 — the present chloramphenicol regimes do not alleviate the
toxemia of the disease for at least 36-48 hours and fail to eliminate the fever until
* This paper presented to the General Session of the American College of Physicians, St. Louis,
April 12, 1950.
f Received for publication July 3, 1951. The contribution of numerous individuals to this study
was acknowledged in previous publications (1, 2).
143
144 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
the fourth day; 2 — relapses of typhoid fever occur in a certain portion of treated
cases; 3 — S. typhosa continue to be shed in the feces for a variable though usually
short period of time after therapy is begun; and 4 — the typhoid carrier state, when
it exists, is not permanently benefited by chloramphenicol.
This present report extends the previously published results pertaining to the clini-
cal observations in patients receiving combined therapy with chloramphenicol and
cortisone and in other patients in whom cortisone was the sole form of treatment
(1, 2). It should be mentioned immediately that the hormone, while producing ob-
vious benefits to the patients, exerted no anti-bacterial effect and did not significantly
hasten the disappearance of 5. typhosa from the blood or feces.
METHODS OF STUDY
A. Selection of Patients. Patients with typhoid fever proved by cultivation of
6". typhosa from the blood or feces were selected for treatment using chloramphenicol
in combination with cortisone or cortisone alone.
TREATMENT
A. Combined chloramphenicol and cortisone. Chloramphenicol was administered
orally at 8-12 hour intervals with a large initial dose of approximately 50 mg./kg.
and subsequent daily doses computed on the same basis. After improvement ensued
the daily dose of chloramphenicol was halved for a total of approximately 10 days.
Cortisone was administered by two different dosage schedules. The first schedule
consisted of 200 mg. the first day and 100 mg. for each of the next 2 days. The second
schedule was 300 mg. the first day, 200 mg. the second and 100 mg. the third day.
It may be seen, therefore, that cortisone was administered for a relatively short period
of time during the course of this illness.
B. Cortisone alone. In the 4 adult patients cortisone was given in doses of 200 mg.
the first 24 hours in divided doses of 100 mg. each. During the second 24 hours, 200
mg. were administered and on the third day 100 mg. The children, aged 5, 7, 8 and 11,
were given approximately one-half the adult dose. One patient who suffered a relapse
received a second course of cortisone.
C. Care of patient. Clinical and laboratory procedures were essentially the same as
those employed in earlier studies by our group.
Chloramphenicol blood levels were performed on a sufficient number of cases to
indicate that the results were similar to those obtained on essentially identical
regimes.
Daily blood cultures were obtained during the pre-treatment observation period
and frequently, usually daily, for one week after instituting therapy. Specimens of
feces and urine were cultured for 5". typhosa at frequent intervals throughout the
period of observation.
The Widal reaction was determined on several specimens from each patient. The
blood was examined by routine hematologic methods but it was not possible under
the conditions of the study to determine the absolute eosinophil count or serum
electrolyte pattern with any uniformity. Seventeen ketosteroids were not deter-
mined.
WOODWARD ET AL— CORTISONE AND TYPHOID FEVER 145
RESULTS
It is worth recounting that our previous experience with the use of chloramphenicol
in the treatment of 44 patients with typhoid fever showed that an average of 4 days
was required from the time the first antibiotic was given until fever and toxemia
disappeared. It is surmised that this delayed clinical response depended upon libera-
tion of toxin from destroyed bacteria and also upon the liberation of toxic products
from the basic necrotic lesion in the intestine. Nevertheless, the 4 day interval of
toxemia and fever appear to be a fairly constant finding in typhoid patients who
receive only chloramphenicol.
A. Effect of Combined Chloramphenicol and Cortisone Treatment. A summary of the
observations on the duration of fever after beginning treatment of typhoid in: 1 — 44
patients with chloramphenicol; 2 — 16 with chloramphenicol and cortisone; and 3 — 7
with cortisone is given in Table I. The table shows that in the 44 typhoid patients
treated with chloramphenicol alone, the average duration of fever after beginning
therapy was 84 hours. This febrile period coincides closely with the findings of sub-
sequent investigators. It will be noted in this table, that of 16 patients receiving com-
TABLE I
Effect of therapy on febrile course of typhoid fever patients
NO. OF PATIENTS
TREATMENT
DURATION OF FEVER
AFTER R<
44
16
7
Chloramphenicol
Chloramphenicol Cortisone
Cortisone
{hours)
84
26
40
bined treatment with chloramphenicol and cortisone that the average duration of
fever was 26 hours. Moreover, in 7 patients receiving cortisone alone for the primary
febrile course, the duration of fever was 40 hours. The results obtained, therefore,
show consistent improvement over the findings in patients treated solely with chlor-
amphenicol.
Combined treatment was followed in all instances by objective and subjective
improvement within approximately 18 hours after instituting therapy. At this time
all patients displayed interest in their surroundings and temperatures began to fall.
Within 15 hours the findings in those patients receiving larger doses of cortisone were
striking. All were afebrile and showed alertness and increased appetite.
Complications of Combined Therapy. The usual incidence of intestinal hemorrhage,
intestinal perforation and relapse in typhoid fever is 3 per cent, 7 per cent and 9 per
cent respectively. In the group of 16 patients who received chloramphenicol and
cortisone, there were no perforations although one developed a moderately severe
gastro-intestinal hemorrhage. The occurrence of six relapses (38 per cent) in a group
of 16 patients therefore represents a higher rate than normally expected in this dis-
ease. The relapse of these patients responded satisfactorily when chloramphenicol
was again administered. It has been previously noted that a high relapse rate results
146
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
when chloramphenicol was administered for 8 days or less, in the neighborhood of 50
per cent, whereas few were encountered when therapy was continued for 2 weeks.
ILLUSTRATIVE CASE REPORTS
1. Treatment with Chloramphenicol Alone. Figure 1 graphically represents the course
of typhoid fever in a patient who received chloramphenicol alone. The patient,
seriously ill, received chloramphenicol on the seventh day of disease. It will be noted
that the temperature reached normal levels in approximately 4 days and in this pa-
tient there was little improvement of the toxic state until the third day of therapy.
Convalescence progressed quite satisfactorily and it will be noted that repeated
patient s , male, age is
I20LB
DAY OF DISEASE
CULTURE
Fig. 1. Course of typhoid in a 15 year old patient treated with chloramphenicol
blood, stool and urine specimens were negative for S. typhosa after therapy was in-
stituted. There was no relapse encountered in this patient.
2. Combined Treatment with Chloramphenicol and Cortisone.
Figure 2 graphically represents the course of typhoid in a 13 year old girl who was
admitted to the hospital on the tenth day of an illness characterized by chills, fever
of 106 F and abdominal pain. Typhoid bacilli were cultured from specimens of blood
obtained prior to initiation of treatment on the twelfth day of disease. Within 18
hours after beginning treatment when she had received a total of 300 mg. of corti-
sone and 7 gm.of chloramphenicol, the patient was noticeably improved and alert.
The temperature reached normal limits within 24 hours and remained normal there-
after. The illness was not complicated during convalescence and the course was one
of progressive improvement. Further attempts to culture S. typhosa from specimens
of blood and feces were negative.
3. Combined Treatment with Chloramphenicol and Cortisone
WOODWARD ET AL.— CORTISONE AND TYPHOID FEVER
147
The course of typhoid in a 27 year old patient is graphically represented in Figure
3. The patient, who was seriously ill and had a bacteremia, showed gross intestinal
PATIENT R.S. FEMALE AGE 13
TYPHOID FEVER
10 I! 12 13 14 15 16 17 18 19 20
S. TYPHOSA
CULTURE
BLOOD + + 00
STOOL 0 0 0
DAY OF DISEASE
Fig. 2. Graphic record of. a 13 year old typhoid patient treated with cortisone and chloram-
phenicol.
N-30, MALE. AGE 27
47 KG
e7 ' ,., T1 65 ., 52
H68 GM%
,0 ,,
S
C
YPHOSA
LTURE
BLOOD
♦
♦
0
0
0
0
0
STOOL
t 0
0
0
0
0
0
0
0
0
URINE
0
0
0
0
Fig. 3. Course of typhoid in a 27 year old man treated with combined cortisone and chlor-
amphenicol. Intestinal bleeding persisted for 15 days.
bleeding prior to the initiation of specific therapy. The rapid return of the temperature
to normal on combined treatment with cortisone and chloramphenicol may be ob-
served. Indeed, the patient's bedside appearance was noticeably improved before
the temperature reached normal. It will be observed furthermore that gross intestinal
148
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
bleeding occurred for 9 days during the course of disease. This is not unusual during
typhoid but the point nevertheless must be considered as to whether cortisone may
have been a factor in continuation of bleeding by delaying healing.
B. Effect of Treatment with Cortisone Alone.
The effect on the febrile course constitutes striking evidence that cortisone therapy
influences the course of typhoid. Examination of Table II reveals that in 7 of 8 pa-
tients cortisone therapy alone was followed by a fall of temperature to normal levels
within 16-73 hours, the average being 40 hours. Furthermore, objective and subjective
improvement was uniformly observed within the first 24 hours of treatment. There
was abatement of headache, weakness and mental dullness within this period. Four
patients were in a semi-stuporous state with profound toxemia which characterizes
typhoid fever. These patients were all markedly improved within 24-36 hours. In
one patient there was no demonstrable effect upon the febrile course although his
clinical appearance was strikingly improved after 24 hours of cortisone therapy.
Chloramphenicol given a week later produced defervescence.
TABLE II
Results of cortisone therapy in 8 patients with typhoid fever
NO. OF PATIENTS
CORTISONE
DURATION! OF FEVER
AFTER R
RELAPSE
DURATION OF BAC-
TEREMIA
4
3
1
Mg
400
600
700
(Hours)
18
73
No effect
1
0
0
(Days)
3
2
4
Effect on the Bacteremia. In 7 patients S. typhosa was isolated from the blood im-
mediately prior to institution of cortisone therapy. In the remaining patient, bac-
teremia was not demonstrated until the relapse. In 2 patients blood cultures found
positive before treatment were consistently negative thereafter. In 5 remaining cases,
5. typhosa was isolated on the second, fourth and fifth days after beginning cortisone,
in spite of the fact that the patients during the bacteremic phase were clinically im-
proved.
Effect on the Stool Culture. Stool specimens were found positive for S. typhosa in 6
patients in one or more instances during convalescence. The longest period that stools
demonstrated typhoid bacilli was the sixtieth day of disease. Xo patient was dis-
charged without three consecutive stool cultures. Cortisone produced no apparent
effect on the occurrence of typhoid bacilli in the feces.
Complication of Cortisone Therapy. Only one of the 8 patients given the hormone
alone developed a relapse. Three patients in this group received chloramphenicol
during convalescence because of persistent typhoid bacilli in the feces. This probably
prevented relapses in their cases. An additional case showed moderate intestinal
hemorrhage on the fifty-fifth day and pericarditis on the sixtieth day of disease.
ILLUSTRATIVE CASE REPORTS
1. Treatment with Cortisone Alone. Figure 4 presents the results obtained with
cortisone in a 27 year old colored female who was moderately ill with typhoid fever.
Therapy was initiated on the ninth day of disease and for 5 subsequent days the blood
WOODWARD ET AL.— CORTISONE AND TYPHOID FEVER
149
continued to show typhoid bacilli on culture. Nevertheless, during this time, the
patient was afebrile and sitting up in bed. Indeed, it was difficult to keep her 'from
walking about the ward. Convalescence was uneventful and there was no relapse.
2. Treatment with Cortisone Alone. The patient whose record is summarized in
Figure 5 was a 7 year old colored child who was rather severely ill with typhoid
fever. Within 36 hours after starting cortisone the temperature had returned to
104 -.
103 -
102 -
101 —
100 -
99
98 -
200 -,
MGM
CORTISONE 75ay" i0°-
PATIENT C.B. FEMALE AGE 27
TYPHOID FEVER
S^y-
I 3 I 4 ! 5 I 6
12113 I 14 1 1 5 ■ 16 1 17 1 18 I 126127 1281
DAY OF DISEASE
S TYPHOSA
CULTURE
BLOOO
¥~
4- 00 + 4-4-4-4-00 00
STOOL
0+ +4- ++ 4- 4-
URINE
+- 0 0 +
WIDAL
0
0 i:320 1160
H
l o i:i60 i:320
E0SIN0PHILES/CUM;V;
33 22 39 8 14 14 14 47 22
SODIUM
ME 9
117
POTASSIUM
5 35
CHLORIDE
91
Fig. 4. Effect of cortisone in a 27 year old female with moderately severe typhoid. Note per-
sistence of bacteremia.
PATIENT T.W MALE AGE 7
TYPHOID FEVER
CORTISONE
MGM
"DAY"
S TYPHOSA
CULTURE
BLOOO
+ 4-++ 0+00
0 0
0
STOOL
0 0 0 04-4-4- + +
4-0 4-
0
4-
URINE
0
WIOAL
0
1 640 1 640
H
i so i eo
EOSINOPHILES/CUMM.
14 81 14 42 17
33 53
SODIUM
MEQ
<
III 128
129
POTASSIUM
42 47
5.0
CHLORIDE
88 94
90
Fig. 5. Graphic record of a 7 year old typhoid patient treated with cortisone. Chloramphenicol
administered during convalescence.
normal. Even before this time, however, this child who was toxic before therapy was
instituted stood up in the crib, showed interest in his surroundings and ate heartedly
On the twentieth day when the patient was asymptomatic, chloramphenicol was
administered because of the finding of a positive stool culture for typhoid bacilli.
3. Cortisone Therapy with Relapse. Figure 6 presents the results of treatment of a
moderately ill patient with typhoid fever who relapsed after cortisone. The tempera-
ture which was 102 F before institution of therapy, became normal within 16 hours
after 200 mg. of cortisone. Bacteremia was not demonstrated prior to therapy. After
10 days during which the patient was entirely free of symptoms, there was a return
of temperature and typhoid bacilli were isolated from the blood. Re-administration
150
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
of 300 mg. of cortisone for 2 days resulted in a complete remission of symptoms and
the course thereafter was uneventful.
PATIENT D.0. MALE AGE 32
TYPHOID FEVER
MOM 2°0-_
r
1 9 ho' II Il2ll3ll4r*5ll6ll7ll8ll9l20l2l I22l23l24l25 Feel 2 7 l2sl29 1 30
DAY OF DISEASE
S TYPHOSA
CULTURE
BLOOD
0 0 0 0 0 0 +
STOOL
0 0 + +0000 + 000000
URINE
0 0 0 0
WIDAL
0
1 1280 1 1280
Fig. 6. Effect of cortisone therapy in typhoid. Note relapse with bacteremia on 26th day of
disease.
DISCUSSION AND SUMMARY
The combination of cortisone with chloramphenicol apparently arrests the acute
manifestations of typhoid fever more effectively than does the antibiotic alone.
Sixteen patients acutely ill with typhoid fever were markedly improved within 24
hours after beginning combined therapy. The average duration of fever in this
group was 26 hours. This represents a shortening of the febrile period in comparison
with that obtained with the usual chloramphenicol therapy.
Cortisone administered as the sole form of treatment in 8 typhoid fever patients
appeared to exert a favorable influence and resulted in amelioration of symptoms.
Cortisone lacks any direct effect upon the toxin of 5". typhosa. Furthermore, this
hormone possesses no direct effect on the typhoid organism since: 1 — there is no evi-
dence of bacteriostatic or bacteriocidal effect in in vitro tests of cortisone and S.
typhosa; 2 — bacteremia and the occurrence of S. typhosa inthefecesare not appreciably
altered in those patients treated with cortisone alone. It appears likely therefore
that the beneficial effect of cortisone in the typhoid patient is the result of action on
the human host rather than directly on the typhoid bacillus or its products.
In the present group of 24 patients, there were 7 who suffered typhoidal relapses.
Six of these 7 relapses occurred in the group of 16 patients who received combined
treatment with cortisone and chloramphenicol. The incidence of relapses in this
particular group is unusually high. Previous experience had shown that very few
patients suffer relapse if chloramphenicol is used over a period of 2 weeks. Such a
schedule was employed here. One must raise the question regarding the possible role
of cortisone in increasing the relapse rate of patients receiving combined therapy.
This question can only be answered when the results of additional observations
become available. However, a number of theoretic considerations are worth mention-
ing at this time.
An extensive literature is already beginning to accumulate on the detrimental
effect of cortisone and ACTH on experimental bacterial infections of animals,
notably those caused by tubercle bacilli (3) and streptococci (4). Certain of these
studies, particularly those of Michael and his associates, in tuberculous infections
WOODWARD ET AL— CORTISONE AND TYPHOID FEVER 151
have been interpreted as showing a suppression of the immunologic response of the
host. There is no doubt about the fact that the cortisone-treated animals of Michael
were more susceptible than the appropriate controls. However, the data might be
explained on the basis of suppression of cellular response of the infected animal
rather than on the basis of suppression of immunologic response. In any case, it is
noteworthy that the untoward effects obtained with cortisone in experimentally
infected animals are noted only after relatively large doses are employed for a rela-
tively long time. In the present group of cases, the serologic response (O and H
agglutinins) of our typhoid patients who received combined therapy or cortisone
alone was not materially different from that previously observed in patients with
untreated typhoid or those who received chloramphenicol.
Another of the physiologic effects of the adrenal hormones which might produce an
untoward effect in typhoid patients is concerned with the suppression of fibroblastic
activity (5). It is apparent that an appreciable suppression of this type might ad-
versely affect the outcome of the necrotic lesions of the intestine. Here again, this
hormonal effect is manifest after relatively prolonged administration. In this series
of 24 patients, intestinal hemorrhage occurred in 2 instances (8 per cent) which com-
pares roughly with the 7 per cent of gross hemorrhage occurring in McCrae's ac-
cumulated series of 23,271 cases. Nevertheless the hazard of delayed healing and its
possible increase in the tendency toward spontaneous rupture of the intestinal lesion
cannot be minimized.
CONCLUSION
It is our opinion that cortisone in typhoid fever assists the patient in suppressing
the toxic manifestations of the disease. The beneficial effects of cortisone are ob-
tained quickly when adequate doses are administered. Therefore, prolonged therapy
with the hormone is not indicated; indeed, 1 or 2 days of treatment is probably
adequate to elicit the maximal benefit as regards this detoxifying effect. Since
cortisone possesses no direct activity against the typhoid organism, the bacterio-
static antibiotic chloramphenicol must be used in the rational treatment of typhoid
fever. Combined therapy with chloramphenicol and cortisone is probably indicated
only in those patients who display marked signs of toxicity.
Dept. of Medicine, University of Maryland School of Medicine, 29 S. Greene St., Baltimore 1, Md.
BIBLIOGRAPHY
1. Smadel, J. E., Ley, H. L., Jr., Diercks, F. H.: Treatment of typhoid fever. I. Combined therapy
with cortisone and chloramphenicol. Ann. Int. Med. 34: 1, Jan. 1951.
2. Woodward, T. E., Hall, H. E., Diaz-Rivera, R., Hightower, J. A., Martinez, E. and Parker,
R. T.: Treatment of typhoid fever: II. Control of clinical manifestations with cortisone. Ann.
Int. Med. 34: 10, Jan. 1951.
3. Michael, M., Jr., Cummings, M. M. and Bloom, W. L.: Course of experimental tuberculosis
in the albino rat as influenced by cortisone. Proc. Soc. Exp. Biol. & Med. 75: 613-616, Nov.
1950.
4. Glaser, R. J., Berry, J. W., Loeb, L. H., Wood, W. B., Jr. and Daughaday, W. H.: Effect of
ACTH and cortisone in experimental streptococcal and pneumococcal infections. J. Lab. &
Clin. Med. 36: 826, Nov. 1950.
5. Howes, E. L., Plotz, C. M., Blunt, J. W. and Ragan, C: Retardation of wound healing by
cortisone. Surgery 28: 177, Aug. 1950.
A VIABLE PEDICLE GRAFT FOR REPAIRING INTRATHORACIC
STRUCTURES*!
A PRELIMINARY REPORT ON TRACHEAL DEFECTS
R. SIM PENTON, M.D. and OTTO C. BRANTIGAN, M.D.
The intimate anatomic relationships of essential structures within the thorax and
the extension of disease often limits the effectiveness of surgery in this region. It
has become necessary to perfect methods for repairing structures, portions of which
must be excised, in order to perform adequate surgery on advanced disease. A viable
pedicle graft is here described which, it is believed, will be useful for repairing a variety
of tracheal, vascular, and esophageal lesions inside the chest. In the following study,
experiences with the use of this graft for repairing experimentally produced tracheal
defects are reported.
The possibility of reconstructing the badly damaged trachea has become more
feasible because of experimental evidence which has accumulated during the past
decade. The remarkable ability of the trachea to bridge defects with fibrous tissue
and respiratory epithelium has made it possible to use a wide variety of materials as
a framework upon which this reparative process may take place.
Successful repair of the cervical trachea has been reported as early as 1911 (1).
However, it has been only in recent years, as more intrathoracic diseases are becoming
amenable to surgical therapy, that methods of repairing the thoracic trachea have
received widespread interest. Taffel (2) in 1940 used free fascial grafts to close small
tracheal defects as reported in a group of experiments on dogs. Defects were produced
in both the cervical and thoracic trachea. The transplants did not appear to remain
viable but were rapidly replaced by fibrous tissue lined with respiratory epithelium.
Nash (3) in 1943, while discussing the treatment of injuries to the larynx and trachea,
agrees that fascia may be useful in bridging defects of this etiology.
While investigating various uses for polyethylene, Grindly and Mann (4)
anastomosed the trachea over molded tubes of this material and later removed the
tubes at bronchoscopy. In 1948 Hanlon (5) used gelatin sponge successfully for
bridging small defects in the trachea and bronchi. Daniel (6) has reported complete
regeneration of the trachea about glass tubing. Flattened epithelium completely
covered the entire luminal wall, and the presence of distinct rings of cartilage approxi-
mated the appearance of the original trachea. Gebauer (7) has found dermal grafts
supported with stainless steel wire to be useful for plastic reconstruction of tuber-
culous bronchostenosis. Gibbon (8) reported a case in which he used a section of costal
cartilage wrapped in a flap of parietal pleura.
After reviewing the previous experimental work on this problem, it becomes evident
that the results obtained have not depended to any great extent upon the material
used as a graft. These materials serve simply as a framework upon which the tracheal
wall may regenerate in the form of fibrous tissue and respiratory epithelium.
* From the Department of Surgery, School of Medicine, University of Maryland.
| Received for publication September 10, 1951.
152
PENTON— PEDICLE GRAFT FOR INTRATHORACIC STRUCTURES 153
The present experiments differ completely. A rectangular pedicle flap consisting
of intercostal muscles, periosteum, neurovascular bundles, and parietal pleura is
mobilized from the chest wall. It is thick, tenacious, and retains an excellent blood
and nerve supply from the intercostal vessels and nerves which enter its attached
portion posteriorly. It continues to remain viable and does not at any time depend
upon fibrous tissue proliferation from the trachea for support. It seems reasonable
to expect that such a graft should be much less likely to slough or to form strictures.
PROCEDURE
AH operations are performed under aseptic conditions. Intravenous sodium pento-
barbital-positive pressure anesthesia is used.
With the dog in a supine position an incision is made along the entire course of the
right 5th rib down to the thoracic cage. The entire 4th rib is now dissected from its
periosteal bed and retracted out of the operative field until it is used again at the
time of closure. The superior margin of the 5th rib and the inferior margin of the 3rd
rib are now freed from their periosteum. Incisions are made along the periosteal beds
of the 3rd and 5th ribs. This strip of chest wall is now divided anteriorly at the costo-
chondral junction (Fig. 1 upper right), freeing a long flap composed of intercostal
muscles, periosteum, neurovascular bundles, and parietal pleura. This graft has an
excellent blood supply, and bleeding is always noted at its free end.
Support for the graft is provided by a "U" shaped section of stainless steel wire
inserted between the external and internal intercostals. The wire is completely covered
by muscle externally, and by muscle and parietal pleura on its luminal side. This
support is anchored in place by interrupted silk sutures. The operator is then able to
mold this wire support into the desired form as the graft is sutured to the defect
(Fig. 1 lower left).
By rotating the trachea on the endotracheal tube, all surfaces are made accessible.
This makes it possible to cover a defect extending about the entire circumference.
As the graft is sutured in place with interrupted silk sutures, it becomes a muscular
tube replacing the section of trachea which has been excised (Fig. 1 lower right). It
is important not to include intercostal vessels in a suture as they enter that portion
of the pedicle which has been used for the reconstruction of the trachea. This could
happen as the tube is being completed and the distal end of the graft is being sutured
to the pedicle at its junction with the trachea. After the defect has been closed, the
endotracheal tube is withdrawn to a point superior to the graft in order to test for
leaks.
The fourth rib now is replaced in its normal position by suturing its costal cartilage
in place anteriorly. No attempt is made to close the defect caused by the removal
of the intercostals and parietal pleura. The muscles superficial to the ribs are approxi-
mated with interrupted silk sutures and the skin is closed with a continuous silk
suture. The endotracheal tube is removed.
RESULTS
In this study, the above technique was used to repair full thickness tracheal defects
on 10 adult dogs. In 5 animals, complete sections of the trachea 3 centimeters in
154
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
length, were removed. The remaining 5 dogs had less extensive defects (2 x 3 cm.)
repaired.
There were no deaths. Bronchoscopy was performed on 2 dogs from each group 6
weeks postoperatively. It was difficult to distinguish the luminal side of the graft
Fig. 1 : Upper left — Orientation sketch of photographs
(1) Viable Pedicle. (2) Vagus Nerve. (3) Phrenic Nerve.
(4) Endo — trachial Tube. (5) Superior Vena Cava. (6) Azygos Vein.
from the surrounding tracheal wall. Two or 3 silk sutures appearing as black dots
along the line of junction with the trachea could be seen in each case. The graft in
those cases in which a complete section of the trachea had been removed appeared
slightly irregular from within, but there was no evidence of stricture formation.
All dogs were sacrificed 2 months following operation. Examination revealed all
PEXTON— PEDICLE GRAFT FOR INTRATHORACIC STRUCTURES 155
grafts to be grown into the substance of the trachea. They were thickened, indurated,
and composed of muscle surrounded by regenerated bone. The formation of
bone about the graft seemed to insure its rigidity. It is impossible to say at this time
whether or not this is an advantage. The tracheal lumens were all smooth, without
appreciable narrowing in any case. Microscopic examination revealed fibrous tissue
proliferation beneath and around the borders of the graft. The epithelium which
covered the luminal side was indistinguishable from the surrounding tracheal
epithelium.
SUMMARY
A method is described for mobilizing a viable pedicle graft from the chest wall
which has proved useful for replacing excised portions of intrathoracic structures. The
graft is composed of intercostal muscles, periosteum, neurovascular bundles, and
parietal pleura. It remains attached to the chest wall posteriorly and retains an ex-
cellent blood and nerve supply from the neurovascular bundles. This is its chief
advantage.
While this method was developed on dogs, it has been used successfully to repair
a large tracheal defect on a human subject.
Note: On August 22, 1951 an extensive tracheal defect was repaired on a patient
at the University Hospital, Baltimore by the method which has been described in
this report. This case will be published at a later date.
Experimental use of the graft for the repair of vascular and esophageal defects is
now being investigated.
BIBLIOGRAPHY
1. Hohmeier, F. A.: A New Procedure for Closing Tracheal Defects. Munchen. Med. Wchnschr.
58: 984, 1911.
2. Taffel, Max.: The Repair of Tracheal and Bronchial Defects With Free Fascial Grafts. Surgery
8: 56, 1940.
3. Nash, R.: Injuries to the Larynx and Trachea. Surg. Gyn. and Obs. 76: 614, 1943.
4. Grindley, J. H., and Mann, F. C: Surgical Uses of Polythene, An Experimental Study. Arch.
Surg. 56: 794, 1948.
5. Hanlon, C. R.: Observations on the Use of Gelatin Sponge in Closure of Experimentally Pro-
duced Defects of the Bronchus. Surg. Gyn. and Obs. 86: 551, 1948.
6. Daniel, R.: The Regeneration of Defects of the Trachea and Bronchi. /. Th. Surg. 17: 335, 1948.
7. Gebauer, P. W. : Plastic Reconstruction of Tuberculous Bronchostenosis with Dermal Grafts.
J. Th. Surg. 19: 604, 1950.
8. Gibbon, J. H.: Discussion of a Paper by Daniel. J. Th. Surg. 17: 335, 1948.
GLOBIN INSULIN WITH ZINC IN DIABETIC OUTPATIENTS*
SAMUEL T. R. REVELL, JR., M.D.
It is not the purpose of this report to discuss the pharmacologic actions of the
various insulin preparations under controlled conditions, but to report our experience
in using globin insulin with zinc in the control of ambulant outpatients. The patients
studied have been, with two exceptions, from the Diabetic Clinic, University Hos-
pital Outpatient Department. It seems pertinent to state that these patients are
either indigent or are in such a low income group that they are unable to afford
private medical care. This economic handicap makes strict dietary control very
difficult. The mental age of this group of patients is distinctly below that of the
average mental age encountered in private practice.
The graphs to be presented are selected as representative of the group of about 60
patients who have been studied during the past 18 months in an attempt to show the
results obtained in the various types of diabetic patients requiring insulin. In the
graphs the curves for weight, blood sugar, and insulin dose are plotted with time as
the abscissas; the curves of glycosuria however are plotted with percentage of the
total number of specimens examined in the period as abscissas.
Figure 1. This composite graph represents a 56 year old white male private patient
with uncomplicated diabetes mellitus, first seen in October 1949, at which time symp-
toms of weight loss, polydipsia, polyuria had been present for 6 months. The blood
sugars depicted in this graph were taken 2 hours after his noon meal. The graph
was selected to show the relative ease of obtaining good control in the uncompli-
cated diabetic with globin insulin.
Figure 2. This composite graph depicts the course of a 56 year old white female first
seen in the diabetic clinic September 9, 1949 because of a palmar abscess of one
month's duration that had failed to heal following surgical incision and drainage.
In addition to her diabetes mellitus she was found to have hypertensive cardio-
vascular disease and arteriosclerotic peripheral vascular disease. Her hyperglycemia
was well controlled although she continued to show moderate glycosuria. Upon
substituting Globin Insulin the control of the glycosuria was markedly improved in
spite of moderately elevated fasting blood sugars. It was necessary to discontinue
the use of globin insulin because of persistent local reaction about the sites of in-
jection. This case was selected to show that globin insulin occasionally produces
reaction about the site of injection. This was the only instance in more than 75 clinic
patients and all of the private patients treated with globin insulin that exhibited
this phenomenon.
Figure 3. This graph depicts the record of a 56 year old white female whose diabetes
was discovered in 1947 when admitted to the hospital for repair of a post-operative
hernia. In addition she was found to have latent syphilis, hypertensive cardiovascular
disease, and obesity, being 50 pounds overweight. In February 1949 insulin therapy
* From the Department of Medicine, University of Maryland School of Medicine, Baltimore.
Received for Publication April 4, 1951.
156
REVELL—GLOBIN INSULIN WITH ZINC
157
was instituted. The 2 middle sections of the graph show the failure to obtain satis-
factory control with various combinations of insulin. The last section of the graph
depicts the same patient during 7 weeks of hospitalization when her dietary intake
was strictly controlled.
CHS. WM. 56
A.R.W.F. 56
C-130 P-80 F-80
I 2 2
/ / V
5 5 5
^^
10 DAYS 8 WKS
115
105
95
300
200
100
0
4 +
2 +
0
7 MONTHS
Fig. 2
M.R. WE 56 C-180 P-70 F-60
160-
140-
300-
200-
>_____-— "
100-
4+-
2t-
o -
__■■■■
BO -
60-
40-
20 -
\fc°-°-a<\>v
M.R.
W.F
56
240-
MAY 8, 1950
240
230-
220-
C-180 P-70
X5 75 Y5
F-
60
230
220
210-
210
200-
200
190-
?
190
180-
170-
160-
150-
T
L / \
u / \
N / \
C / >
H /
S
U
P
P
E
R
180
170
160
S^ 150
140-
140
130-
130
120
i
I
1 1
1
12 months 10 weeks 7 weeks
Fig. 3
12 N. 2 RM.
TIME
Fig. 3A
4RM. 6RM. 8PM
Figure 3 A. This is a 24 hour blood sugar curve on the patient shown in Figure 3.
This patient represents one of the common findings in private practice and out-
patients, namely, obesity and failure to follow dietary instructions. This particular
patient had in addition, the complicating factors of latent syphilis and hypertensive
cardiovascular disease.
158
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Figure 4. This graph depicts the course of a 46 year old colored female whose
diabetes was first discovered in 1943 at which time she was 25 pounds overweight.
For 4 years her diabetes was satisfactorily controlled on small doses of protamine
zinc insulin. Following a hysterectomy and appendectomy her insulin requirements
steadily rose as did her weight, with poor control of her diabetes. In March 1950 her
diet was reduced and her insulin changed to globin. The patient continued to exceed
her diet, but the glycosuria markedly improved in spite of the fact that the fasting
blood sugar determinations remained elevated.
Figure 5. This graph depicts the course of a 47 year old colored female whose dia-
betes was discovered in January 1944. At that time she was 70 pounds overweight.
From January 1944 until August 1949 the patient continued to exceed her diet and
steadily gained weight with poor control of her diabetes. In August of 1949 the
patient was placed on a 2 to 1 insulin mixture, and during the 8 week period of ob-
HW C.F 46
C-200 P-75 F-90
Fig. 4
servation her diabetes was satisfactorily controlled. The same patient on a slightly
reduced caloric intake, had globin insulin substituted for the 2 to 1 mixture. As seen
in the graph there was no appreciable change in the blood sugar levels but there was
continued improvement in the amount of glycosuria. As is obvious from her weight
graph, she did not follow her reducing diet. The patients depicted in Figures 4 and
5 represent a common type of individual seen in diabetic outpatient work, namely,
the uncomplicated, obese, insulin-resistant diabetic.
Figure 6. This graph depicts the course of a 27 year old colored female, a known
diabetic of 12 years duration. She was first seen in the Diabetic Clinic in the summer
of 1947 at which time she was 60 pounds overweight and 7 months pregnant. The
obstetric history revealed 2 previous pregnancies which had terminated in still-
births. She had never followed a diet but had taken regular insulin, 15 units three
times daily. During the remainder of this pregnancy she was maintained on regular
insulin twice daily and was delivered of a live baby by Caesarian section in August
1947. For the 6 months following delivery the patient totally disregarded her diet
REVELL—GLOBIN INSULIN WITH ZINC
159
and stopped taking insulin. She returned to the clinic in March 1948 at which time
she was started on protamine zinc insulin. In July of 1948 she again became pregnant
and again did not follow her diet. Her insulin doses were progressively increased
without good control, but in spite of this she was delivered by elective section of a
live baby in February 1949. The last section of the graph shows the same patient on
globin zinc insulin and a 25 calorie-deficit diet which she failed to follow. After 6
weeks of globin zinc insulin alone, protamine zinc insulin was added because of the
persistently high fasting blood sugar and moderate glycosuria. This case was selected
to show the combined problems of the insulin resistant, obese diabetic, the effect of
diabetes on pregnancy, and lastly, the possibility of supplementing globin insulin
with protamine zinc insulin.
Figure 7 . This graph depicts the course of a 67 year old white male who was first
seen in the Diabetic Clinic in December 1940 at which time he was 100 pounds over-
C-ISO P 60 F-50
// 2/ 2/
5 5 5
J.B.T. W.M 67
Hi
C-140 P-60F-II0
X 2«h
2 240r
u 220-
* 20O-:
« l8£H
3 300
a 200
o
o
^ 100-
<
| 4t -
O 2+-
!S> -.
C-140 P-6C
F-IIO
C-175
P-75
F-70
260
240
220
200
180
200
100
Fig. 6
Fig. 7
weight. At that time he had diabetic peripheral neuritis manifested by a wrist drop
and a foot drop. For 5 years diet was adequate to control his glycosuria and hyper-
glycemia. In 1945 he began to experience hyperglycemia and glycosuria with some
weight loss. At that time he was started on protamine zinc insulin. In February 1950
he was placed on a 750 calorie-deficit diet and the insulin was changed to globin. This
failed to control his glycosuria. During the last 3 weeks of observation the globin
insulin was given in divided doses with resulting satisfactory control of the hyper-
glycemia and absence of the glycosuria. This case was selected as an instance of an
insulin resistant, obese diabetic that was complicated by a diabetic peripheral neu-
ritis.
Figure 8. This graph depicts the course of a 52 year old white female first seen in
the Diabetic Clinic in 1949 at which time she was 90 pounds overweight. She had
been a known diabetic for 10 years having been initially discovered in 1939 when
admitted to another hospital in coma. During the subsequent 10 years she was
admitted, on 8 occasions, to several Baltimore hospitals in coma. During this interval
160
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
bilateral lumbar sympathectomies had been performed because of peripheral vascular
disease. In March 1949 she suffered a cerebral vascular accident. When first seen in
the Diabetic Clinic she was placed on a salt-free reducing diet and started on globin
insulin. She failed to follow her diet and in spite of steadily increasing her dose of
insulin she was poorly controlled. In April 1950 she was admitted to the University
Hospital for control of her diabetes and ligation of bilateral varicose veins. The last
section of the graph shows her hospital course under controlled dietary conditions.
MR WF 52
C-135 P-55 F-40 SALT FREE
C-II5 P-40 F-35 SALT FREE
HOSPITAL DAYS
Fig. 8
M.R.
MAY 5, 1950
BLOOD SUGAR CURVE
6L0BIN INSULIN 60
UNITS
C-M5 P-40
F-35
'5 '5 '5
170-
188=
M0-
130-
120-
110-
ioo—
L
U
N
C
A H
S
U
P
P
E
R
i i i i
I l
1 1 1 1 1 M
8 10 12 2 4 6 7 9 II
Fig. 8A
Figure 8 A. This depicts a 24 hour blood sugar curve on the same patient shown in
Figure 8. This case was selected to demonstrate the excellent control of severe diabetes
when all factors can be controlled. It shows in addition, the safety factor of globin
insulin in a severe diabetic outpatient who refused to follow instructions even though
satisfactory control is not maintained.
Figure 9. This graph depicts the course of a 38 year old colored male first seen in
the Diabetic Clinic in 1946 in mild acidosis. He was given diet instructions and taught
the self-administration of insulin and returned to his family physician. The patient
REV ELL— GLOB IN INSULIN WITH ZINC
161
was returned to the Diabetic Clinic in August 1948 out of control and suffering from a
generalized pydodermia. His insulin requirements rapidly rose and control remained
very unsatisfactory with hyperglycemia and marked glycosuria. In September 1949
this patient was placed on globin insulin and protamine zinc insulin. His control
remained completely unsatisfactory because of numerous hypoglycemic reactions.
At the end of this period of observation he developed lobar pneumonia and entered
D.H CM. 37
CI75 P80F NO
160 -
140-
120-
400^
300-
200-
-A
100-
0 -
4t-
2+-
0-
30%
■- |
140 -:
120-
100-
80-
60-
;H
C 250 P dO F 90 C ;
I, 2, 2,
7 MONTHS 5 WKS.
Fig. 9
C-200 P-120 F-IIO
C-200 P-120 F-IIO
'/ 2/ 2,
Fig. 10
the hospital in severe acidosis. In the last section of the graph insulin was adminis-
tered in divided doses of globin. During this period his control was completely satis-
factory with absence of insulin reactions, satisfactory blood sugars, and minimum
glycosuria. This case and the one to follow were selected to depict one of the most
difficult problems in the management of diabetic patients, namely, the juvenile or
"brittle" diabetic. The degree of control accomplished by 2 doses of globin insulin
in these patients was far greater than that obtained by any other method.
Figure 10. This graph depicts the course of a 36 year old white male private patient
162 BULLETIN OF THE SCHOOL OF MEDICI XE, U. OF MD.
who was first seen in February 1950 in mild acidosis as the result of an upper respira-
tory infection. The patient had been a known diabetic for 19 years. He had been
well controlled by diet and small doses of protamine zinc insulin until 19-18 when he
was admitted to another hospital in coma. He was readmitted to the same hospital
6 months later in moderately severe acidosis resulting from a streptococcal throat
infection. During the subsequent 2 years he had been maintained on a diet and was
taking protamine zinc insulin 32 units, and crystalline zinc insulin 10 units. On this
regime he had experienced hypoglycemic reactions averaging at least 3 each week.
Because of his past history an attempt was made to control this patient on globin
insulin in a single dose, but he continued to exhibit hypoglycemic reactions although
not so frequently as previously. The second portion of this graph shows the same
patient on globin insulin in divided doses with additional improvement but still some
hypoglycemic reactions. On May 26, 1950 a diurnal blood sugar curve was performed.
This is plotted in the upper right hand section of the graph. Following demonstration
of the hypoglycemia at 5 P.M. the patient was given a cup of milk and crackers in
the mid-afternoon with complete elimination of insulin reactions.
Subsequent to these observations this patient developed severe diabetic retinopathy
and nephropathy, probably of the intracapillary glomerulosclerosis type.
SUMMARY
An attempt has been made to present the results obtained in ambulant diabetic
patients of varying type and severity using globin insulin. The cases selected are
believed to be representative.
CONCLUSIONS
1. Globin insulin has been found to be an effective form of substitution therapy in
the diabetic patient requiring a relatively small dose of insulin for satisfactory control.
2. Globin insulin has been found to exhibit a moderately wide range of safety in
diabetic patients whose failure to follow instructions had led to repeated instances of
diabetic coma.
3. Globin insulin in divided doses has been found to be an extremely efficient tool
in the successful management of "brittle" diabetics.
Burroughs Wellcome and Company (U. S. A.) Inc. generously supplied the globin insulin with
zinc for this study.
CONCERNING VALUES IN MEDICLNE*f
JACOB E. FINESINGER, M.A., M.D.
This evening marks a special event to you, members of the class of 1950, to your
families, to your friends, and to your teachers as well. It marks the completion of a.
phase of years of preparation and study. To many it is the culmination of years of
saving and denial. Your efforts and those of your families have been successful and
have resulted in your being welcomed into the fellowship of physicians. You, and your
families as well, are to be congratulated on this achievement. Your teachers have
now truly become your colleagues. They, too, I am sure can justly feel the satisfaction
of having played a part in guiding you to the status of physician with all the privileges
and responsibilities that go with this status. I am merely spokesman for many who
hold high hopes for you in pursuit of your chosen career.
You are taking your part among a group of men and women who have given sup-
port and relief to their fellow man. These men and women represent links in an
age-old chain going back into antiquity. Theirs is a tradition of effort and achieve-
ment dedicated to the welfare of man. This desire to lessen suffering has been the
consistent aim in the lives of physicians, leading all the long way from medicine man
with his magic rites to the modern doctor with his methods of diagnosis, therapy and
prevention. In our days the profession of medicine represents a unique opportunity for
work and satisfaction. Above all other professions, perhaps, it makes use of scientific
method in the service of human and personal goals — the practice of the healing arts.
Through his daily work the doctor brings the results of his knowledge, skill, and in-
vestigations to the needs and the sufferings of his patient. His is not a life of pure
scholarship in quiet halls of comtemplation. He works with life itself. At no point can
he get away from the need to consider and to help his patients — and yet he must do
this with imperfect tools and incomplete information. He must draw from the best
that is available and direct it to serve his goals. He must be objective and sound, and
at the same time resourceful and patient. He must have the rare qualities of adapting
scientific generalizations to the service of the individual patient. His task is a trying
one. It requires an unusual combination of human traits.
For this evening's talk I have selected the topic of values in medicine. By values
we mean certain preferences which are important to us as doctors and as civilized
human beings. Some of these preferences we state openly. Others are implicit in our
behavior. As a modern civilized human being, I may prefer peace to war, and a gen-
eral increase of human welfare and happiness to the guarding of special privileges.
These preferences will be shown in much of my behavior, in various ways. I may
merely talk about them. I may have a pleasureable feeling when I think about them,
or they may influence many of my actions. I may prefer the free expansion of knowl-
edge to the limitations imposed by authoritarian decree. I may prefer freedom of
thought and speech to suppression. In choosing the profession of medicine, you and I
* From the Department of Psychiatry, University of Maryland School of Medicine. Baltimore.
f Read at the Pre-Commencement Exercises, University of Maryland, School of Medicine, June
8, 1950.
163
164 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
both show evidence of a preference for sustaining human life, for health, for growth
toward full maturity — otherwise, it would be difficult to understand why we have
chosen to be physicians.
In the course of our busy lives as students, teachers and doctors, we find little time
for the consideration of our values. They seem so obvious. As we rightfully become
concerned with our job — with the cure of patients — we tend to pay little attention to
the values and the motivation which make it important for us to cure and to help
patients. Traditionally, the doctor's values have included broad concepts, such as the
preservation of life at a high level of health and the spread of medical care. These
broad general values are familiar to and accepted by every physician, and for that
matter by every civilized man. Yet we feel that it is pertinent to ask, how helpful are
these general values in our lives as doctors working with patients? Values are not too
useful if they remain merely as thoughts or ideas which give us good feelings as we
state them or hear about them. We would suggest they are meaningful to us in our
work only insofar as they are translated into specific attitudes and concrete actions
geared to help us in the situations which we meet in the practice of medicine. This
implies in essence breaking down these broad concepts in terms of our every day be-
havior. In doing so we begin to deal with more specific actions directed more closely
to our work. We should like to check and evaluate these actions as to their effective-
ness. Do these values tell us what to do? or what to say? Do they direct our behavior,
and if so, is this behavior worth while? The idea of alleviating human suffering is little
more than a slogan until we find and apply techniques to relieve pain in the individual
patient. In other words we should question the usefulness of the general principle as
such. We would feel that values are important as they lead us to operational defini-
tions and procedures.
Most of the decisions which you young physicians are about to make will be based
on the relative importance which you attach to certain values. These decisions are not
simple. In the first place each of us wants to be a good doctor. This itself involves a
very crucial judgment value — namely, what is a good doctor? In order to answer this
question it is necessary to define the word "good" in respect to specific situations.
What does the good doctor do in respect to his relation to his patients or to his work?
How does the good doctor act in respect to the body of medical knowledge and its
growth, or to his colleagues and students and to his community? In each of these
instances which deals with the doctors' behavior, it would also be necessary to work
out ways of describing and assessing the behavior. Each of these questions involves
judgment of objective values, by which we mean values that can be measured in terms
of behavior. At this stage of your careers you are concerned with training. What con-
stitutes good training? Later on you may be faced with decisions involved in the
practice of medicine. You may be concerned with your position in the community,
your financial status, your hospital connections, your relationships with your patients.
Decisions in all of these matters involve the relative hierarchy of certain values — that
is stressing the importance of certain values above others.
Many of us are aware of some of the values behind our motives, which in turn
affect our behavior. To others this awareness seems not so necessary. You may be
wondering this very minute — how important can all this be to me, who have already
FIN ESI NGER— VALUES IN MEDICINE 165
made some major decisions in life. Is it really necessary for me to be concerned with
these never-ending problems? I want to be an internist and after several years of
training, I can reasonably look forward to a successful and useful career as a doctor.
I need not concern myself too much with these matters. They can be left to hair-
splitting metaphysicians whom we have left far behind, mummified in college courses.
Usually the values underlying our decisions are not apparent. They are implicit. How-
ever, the day does not go by in the life of the physician when he is not called upon to
behave in certain ways: — should he tell the patient the truth about his cancer? Should
he refuse to give the demanding patient sedatives at the risk of losing him to another
doctor who may not be so scrupulous? Should he make promises to the patient which
he knows he cannot carry out? In such problems the doctor cannot avoid considering
his values. In situations of this kind, when he does not quite know what to do, the
doctor is forced to act, whether or not he is aware of the values involved. If he is
naive, or unaware of the values involved, and if his behavior appears consistent, he is
likely to be acting in accordance with values derived from one of two possible
sources. He is either applying so-called common sense to the situation, or he is taking
over ready-made values offered to him, usually emanating from some other institu-
tion or discipline. In either case his performance under these circumstances may not
be in line with the most effective medical practice.
Common sense as a sound basis for behavior can be delusory. This may sound sur-
prising, perhaps even paradoxical. Common sense would tell us, as it told our an-
cestors, that the sun moves across the sky. It is obvious — you can see it. Yet this is
not the case, as we know from well-established facts. Common sense reasoning would
dictate that cancer patients should preferably be spared the dread knowledge of their
diagnosis. Yet recent study indicates that most cancer patients make a more satis-
factory adjustment and utilize their capacities better when their diagnosis has been
discussed in detail with them by their doctor. Common sense would tell us that we
could control our behavior if we only wanted to. Yet recent work in my own specialty
has shown that symptoms and much of the behavior of patients — and doctors too,
I suppose — may be determined by unconscious factors — factors that we are not aware
of. Inferences from common sense can be frequently misleading. As doctors we want
to be on our guard against their indiscriminate use.
We must also be careful in completely accepting the judgment values which come
from other institutions. These values may be based on outmoded information. They
may derive from rigid groups or institutions established by society for purposes which
in many ways differ from and are at variance with those of the scientifically oriented
doctor.
We believe that the doctor's behavior is based in a great measure on judgment
values — whether or not he is aware of these values. It would seem that the doctor who
is aware of the values underlying his behavior, is in a position to operate more effec-
tively and realistically in working with his patients. Awareness itself may alter the
behavior of the doctor. It is possible that he will then understand more completely
and as a result become better equipped to deal satisfactorily with his patients as
individuals — and with their physical, mental, and social adjustments. Certainly our
decisions will be more meaningful if we can be aware of the particular value or series
166 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
of values involved in these decisions, whether they be ethical, aesthetic, personal, or
social.
There are obviously a host of value judgments which come to the fore whenever
any matter of preference is considered. Some of the doctor's values are no longer con-
troversial— though they were fiercely fought over in the past. Today, for example,
we all accept the use of asepsis, vaccination, and some of the contributions of epi-
demiology. Once scientifically established, these have now become an integral part
of the doctor's system of values, and he behaves accordingly. As more and more
scientific facts are discovered, the doctor's values change, keeping pace with this
expanding knowledge. There still remain burning issues which have not been settled
because knowledge is incomplete or inaccurate. Further, there remains the problem
of what should be the doctor's attitude toward questions that involve insufficient
knowledge, controversial questions, in medical practice, medical service, or other
matters involving human and social problems.
I do not propose to give answers to the many questions I have already raised. I
should merely like to suggest that these issues are important and have a practical
bearing upon our work. More recently they have been the focus of discussion by
many scientists and philosophers. There is a growing body of opinion that the problem
of values cannot be treated haphazardly. It needs the joint efforts of people working
in many disciplines.
It is true that many of the traditional problems with which metaphysicians have
been concerned are off in an orbit far removed from the hurly-burly and pressures
of the doctor's world. Within our generation there has, however, risen a school of
philosophers deriving from British Empiricism and from iVmerican Pragmatism, who
have taken to heart the problems of the doctor and the scientist in his need for clarity.
The work of these empiricists or positivists — Ernst Mach, Rudolph Carnap, Philipp
Frank — has been of inestimable value to many scientists. They have pointed out
that the traditionally idealistic philosophers starting from Plato and Aristotle have
put their statements in such a way that they cannot be checked, and are not subject
to verification by direct observation and by other tools of the scientist. The meta-
physicians have been helpful in developing systems of logic and clear thinking. They
have been satisfied, however, to apply logic toward the solution of problems which
can never be solved by recourse to objective fact. Furthermore, they have made
broad use of arguments from analogy, which can be misleading. This is in marked
contrast to the orientation of the positivist who insists that we set up problems in a
form which can be proved or disproved by observation and measurement. One of the
striking values of this approach is that it allows us to predict and ultimately to
utilize and control the phenomena in the world about us — whether these phenomena
are in the realm of the physicist, the chemist, the physician or even the sociologist
and economist.
I, myself, am obviously no professional philosopher, yet I have been impressed
as a physician with the need of a clearer understanding of these involved matters,
especially as they bear upon our decisions and practical work. It would seem worth
while in our busy lives to take stock of our own personal preferences or values and
those of the members of our own profession. Such stock taking and fundamental
FINESINGER— VALUES IN MEDICINE 167
questioning need not be reserved for rare academic occasions such as this. The doc-
tor's job also involves the constant questioning of his behavior in terms of its effec-
tiveness in the light of our increasing knowledge. This questioning attitude, the re-
fusal to take anything for granted, is basic in the workaday life of the scientist.
This brings us to the question of how can we find out what values determine the
doctor's behavior? Is there any operational approach which we can use to get a
meaningful answer? Can we pick up any leads by watching the doctor's behavior?
If one wants to determine values in medicine there are at least two obviously avail-
able approaches. The first is to ask the practitioners of medicine for statements re-
garding thsir motivation or for statements regarding their ethical values. Why do
you want to cure patients? Why are you against or in favor of socialized medicine?
These replies could be studied, but here we would be dealing with expressions of
conscious ideas. We might guess that the collection of such material would show
considerable variation and marked difference of opinion. Material of this kind would
tell us the verbalization, of doctors, but might give no clue as to whether such values
were actually carried out in practice. Who knows, we might even find a considerable
discrepancy between these verbalized statements and the actual operational be-
havior. Further, such replies would not consider the unconscious factors operating
in the choice of values.
Another and probably more meaningful way would be to observe the behavior of
doctors and from their behavior to draw the appropriate inferences. As one observes
doctors in action, their attempts at saving and maintaining life, their efforts at re-
lieving pain and suffering, their attempts at careful observation and the use of scien-
tific methodology — one is forced to infer that physicians have reasonably consistent
values in reference to their work. These values might be briefly summarized in two
categories: The first dealing with purposes and goals — the saving of human life, the
amelioration and prevention of pain and suffering, and the broadest dissemination
of medical treatment to the population at large. The second category is concerned
with the method of achieving these goals — namely, the use of an approach and of
methods which involve the description of the phenomena, the establishment of cate-
gories, the development of hypotheses and their validation through observation and
experiment. These values have much in common with those of the scientist. By
virtue of the complex nature of the doctor's work — of the various roles he has in the
life as well as in the treatment of his patients — he, of necessity, becomes more aware
of the human and social values.
It is difficult to take issue with such an impressive and high sounding list of values.
Why then, can we not consider the selection of values in medicine a closed matter
and turn our attention with relief to specific workaday problems, as doctors and
medical specialists?
That these are not closed matters can be seen from a more careful scrutiny of the
doctor's behavior. At the same time that we are concerned with alleviating suffering,
we are also concerned with earning a living, which to most doctors means practice
and an office, and overhead, and the manipulations necessary in developing and
holding on to a practice. Physicians in academic life have their own mundane prob-
lems too, connected with competition, advancement and the creation of oppor-
168 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
tunities for work. Often it is difficult to apportion one's time between study and more
practice. There will be decisions to be made involving certain therapeutic procedures
which may be lucrative but of uncertain therapeutic validity. The doctor who is
concerned also with investigation will have to make decisions involving procedures
which may advance our knowledge at the expense of some inconvenience or even
discomfort to patients. The dissemination of medical care to the population at large —
which is a broad general value readily verbalized — may in practice bring up certain
difficulties. A system that will bring comprehensive medical care to the masses of
people who need it may mean that many individual doctors will earn less money.
Such a system might also involve the danger of a leveling off from high standards of
individualized treatment of patients. This, too, is undesirable and runs counter to
our general values. We might digress to point out that in this current highly contro-
versial matter, it is crucial to state the issues in operational terms. We must state
the question — how can we arrive at a workable solution? What would we have to
do to make a particular system work? It is difficult to be cool and objective in setting
up the appropriate studies and to evaluate them objectively. Yet we all agree that
some change is necessary. Maybe the first operational step is to examine existing
systems from a constructive point of view, to eliminate the bad features, and to pre-
serve and amplify those that are useful. It is so easy — yet so unproductive — to state
and restate high sounding slogans — which represent extreme non-operational points
of view.
As doctors we do not live in a social vacuum. We are human beings who are re-
sponding to economic and social pressures as well as to the tenets of Hippocrates.
In other words we are dealing with competing values. Conflicts ensue, and the de-
cisions become perplexing and difficult. The honored and high sounding broad general
values, to which we all do service, resolve themselves into myriads of decisions which
require thought, and which above all must weather the test of experience.
In dealing with conflicting values, it may be wise to take stock and decide as to
the hierarchy — which things come first. It may be necessary to qualify our values,
and restate them more precisely taking into consideration how they actually work
out. We can distinguish and separate out the effective elements — those which in-
fluence our actions from the verbal elements — those which do not influence our ac-
tions. If I may repeat, in instances involving conflicting values, the operational ap-
proach would be to reconsider the value or values involved to separate and retain
the part which as meaningful discourse leads to action — from the part which as
empty talk leads to further abstraction and as such can be dispensed with. To quote
a statement of Charles Saunders Pierce dealing with belief as cited by Frank — "The
essence of belief is the establishment of habit ; and different beliefs are distinguished
by the different modes of action to which they give rise. If beliefs do not differ in
this respect, then no mere differences in the manner of consciousness of them can
make them different beliefs".
The values of the doctor are not static. This can be seen from a perusal of the his-
tory of medical practice. Values are constantly changing. We can see how the results
of scientific knowledge are incorporated into our system of values. The important
discoveries in medicine during the past century offer cogent illustrations. It is hardly
FI N ESI NGER— VALUES IN MEDICINE 169
possible for the modern surgeon to witness violations of the principle of asepsis with-
out reacting violently. The principle of asepsis, which was the result of scientific dis-
covery, has so crept into our values, that any breach of technique brings about an
emotional reaction in the well-trained doctor. It is contrary to our values as doctors
to tolerate anything which results in the spread of communicable disease. We are
gradually reaching the state of development which will not tolerate the spread of
outmoded ideas about personality and human behavior.
As doctors we are accustomed to operating in a world of changing values, and it is,
I believe, realistic to recognize this fact. This does not imply that our values are ac-
tually whimsical or that they respond by a change in direction for each new experi-
ment. To be sure there are instances which accepted values seem to swing about in a
circle responding to still incomplete information or incorrect inference. An example
of this from pediatrics is the shift in attitudes towards feeding schedules. Of im-
portance to us as doctors is an understanding of the factors that bring about this
change in our accepted values. These factors may come from various sources. I would
consider that those changes which come as pressures from political institutions, or
other non-scientific organizations or cults, seldom stand up to the rigorous test of
experience. The other and far more lasting changes in our medical values seem to
come from the convergence of evidence derived from new findings added to well es-
tablished knowledge. The fact that values change need not disturb us. A reasonable
attitude is to consider our medical values as satisfactory guides to action so long as
they represent inferences from the best available knowledge and experience. We
must, however, allow ourselves sufficient flexibility to consider newer values on the
merits of newer evidence and broader experience. Perhaps this is a workable rule
when applied not only to the values of the doctor, but to those many other values
as well that affect our behavior in general.
As to the origin of these ethical or social values, it may be that they have come
from a variety of sources, each interacting with the other. Some would contend that
our values for the good life are ultimate and inflexible imperatives that come to us
from religious leaders and philosophers. On the other hand one can observe that not
all the values stated by religious and ethical leaders have remained. There seems to
be a process of selection going on which discards certain values and supports others.
Hence, there is another point of view, which happens to be closer to my way of think-
ing. This point of view considers that our ethical values have gone through an evolu-
tion in which trial and error has played a significant part. Our current values would
then be the resultant of a process closely related to our social experiences. As civiliza-
tion advances — even though the advance is slow and disheartening at times and by
no means uniform all over the world — many experiences converge to make people
discard outmoded values and accept new ones. The values associated with the state-
ments: "An eye for an eye. A tooth for a tooth.", prove less useful to society and are
supplanted by other values, which operate so as to favor the growth of the individual
towards full maturity in a democratic society.
I find it hard to leave the questions of the values of the doctor without some con-
cern as to his values as a citizen. The doctor is not only a trained professional worker
in the community. He is a citizen as well and as such has a certain status and role
170 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MB.
with the inherent privileges and responsibilities. It is not too important to consider
whether he is a doctor first or a citizen first. What is important is the recognition
that a certain harmony of both roles is needed for effective living. There are many who
believe that the problems of the choice of values is not the concern of the doctor.
His job is merely to cure people, to relieve their suffering. Once this is accomplished,
his job is completed. The same idea is often held in appraising the role of the scien-
tist. It is alleged that the scientists' job is merely to determine how things work
whereas the quest for values is beyond his legitimate sphere. This implies that the
doctor and scientist must obtain their values ready-made for them by others. To
my way of thinking, this is a debatable issue. I consider the selection of values too
closely tied up with our goals and even our procedures, as doctors. Values might
come to us ready-made — their origin and source is not too important, but we must
be free to assess, to qualify, and to modify them in light of our own individual or
collective experience.
I believe that our job as physicians and citizens does not end with the cure of the
patient. We cannot avoid being concerned with: Cure for what? In other words what
kind of a world are we going to send our patients back to? On two counts we can
consider this a legitimate concern. In the first place it may well be that many of the
factors that cause exacerbation and persistence of illness find their home in the social
situation. In the second place we may be reluctant to invest our time and efforts in
work which is likely to be undone by others at the mere stroke of a pen. It would
seem highly inefficient, to say the least, to cure people and have their lives snuffed
out by the atom bomb or by the other horrors of modern warfare. We cannot expect
to achieve our values as doctors, if we remain indifferent to the factors operating in
social and economic spheres. Here, too, we would hope that the application of op-
erational criteria will be productive in the gradual solution of these human and social
problems.
The job of the doctor has much in common with that of the scientist. The orienta-
tion is the same; the methods are the same, and the values are the same. They both
recognize that we live in a changing world — our methods, our information and even
our values change. By virtue of the special therapeutic relation between the doctor
and the patient, the doctor obviously must place more emphasis on a greater under-
standing of human values. The awareness of these factors in our behavior as doctors
makes us more realistic in our work, more considerate in the selection of our goals,
and more rational in our ideals. We do not consider any issue a closed issue and re-
fuse to take anything for granted. We wish to make our incomplete knowledge more
complete. This point of view leads to the idea and hope of unlimited progress in
thought and life. The very fact that we this evening are discussing matters which
involve new plans and new work indicates to me that there is a future for us, with
many places to go.
As young physicians, ready for the next step in your careers, yours is the oppor-
tunity of working together along these lines. We cannot see how this point of view
and its correlaries can fail to increase the welfare of our patients.
TENDON FORMS FOR USE IN THE TREATMENT OF
SEVERED TENDONS*!
ERWIN R. JENNINGS, M.D., GEORGE H. YEAGER, M.D., and
OTTO C. BRANTIGAN, M.D.
Methods for repair of severed tendons have long been of interest to the surgeon.
Because results in tendon repair are frequently unsatisfactory, a practical method of
correlating and tabulating techniques with end function is being attempted. It is
believed that analytical comparison of techniques will ultimately lead to the develop-
ment and acceptance of a method productive of more satisfactory results.
In order to tabulate techniques employed with end results of tendon repair, a
standard form or patient's record is being used at the University Hospital. For pur-
poses of further development and comparison, several techniques and routines have
been established.
The tendon form, as well as the basic principles observed, are herewith presented.
TENDON FORM
This form is designed for the purpose of easily demonstrating the extent of the lesion
and the method of repair. The diagrams purposely avoid lengthy descriptions, the
intent being to precisely indicate the tendon or tendons involved. By correlating the
anterior-posterior with the cross-sectional views, the superficial wound can be drawn
in and the tendons involved can be designated by circling the related area. Concomi-
tant injury of nerve and bone can be listed in the designated space and thus insure a
more thorough correlation with the ultimate outcome.
Suggestions for follow-up data have been placed on the back of the standard ten-
don form. This assures complete information from the time of injury to discharge.
Posted routines at this clinic are as follows:
(a) ACCIDENT ROOM
After determining the extent of the lesion, the wound is flushed with 1000 cc. of
sterile saline, and a sterile dressing applied. Tetanus toxoid or antitoxin is given as
indicated.
(b) OPERATING ROOM
1. All tendons are sutured in the operating room under aseptic conditions by a
surgeon specifically assigned to this problem.
2. In general, tendons are not sutured if the wound is grossly contaminated. This
statement is flexible and is left to the discretion of the operator. Free ends of nerves
and tendons may be identified with non-absorbable sutures, providing extensive
dissection is not required.
3. In the operating room, the wound is washed gently with sterile green soap and
sterile water. Wound edges are cleansed with ether, alcohol and tincture of merthio-
late.
* From the Department of Surgery, University of Maryland School of Medicine and the Uni-
versity Hospital, Blatimore, Maryland,
t Received for publication May 20, 1951.
171
172
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
TENDON FORM
Name
Address
Duration of Injury
Right
Bones
Vessels
Nerves
Tendons
Age
ATS
Left
Sex Race
How Injured
Chemotherapy
Date
No.
-FLEXOR CARPI RADIALIS-
-MEDIAN NERVE-
-PALMARIS LONGUS
-FLEXOR DIGITORUM SUBUMAS
-ULNAR NERVE- -
-FLEXOR CARPI ULNARIS---
-EXT. CARPI ULNARIS--
■—EXT. DIGITI OUINTI
EXT. DIGITORUM COMMUNIS -
-EXT. INDICIS PROPRIUS ■
EXT. POLLICIS LONGUS-
Suture Material
Method of Suture
Length of Time of Immobilization
Report to Residents Clinic
Signed
JENNINGS ET A L— TENDON FORMS FOR SEVERED TENDONS
173
4. Fine steel wire is used as suture material.
5. Suture technique is the responsibility of the surgeon and is recorded by diagram.
6. Hemostasis is aided by the use of a tourniquet.
7. If both the Flexor Digitorium Sublimis and Profundus are severed within the
flexor tendon sheath, only the Flexor Digitorium Profundus is sutured. The Flexor
Digitorium Sublimis may be removed for a distance of one centimeter proximally and
distally.
8. Antibiotics or chemotherapeutic agents, according to the preference of the
surgeon, are used for a minimum of four days.
9. All affected tendons are immobilized for three weeks. Immobilization in posi-
tions of extreme flexion or extension are avoided.
10. A tendon form must be completed for every patient.
FOLLOW-UP SHEET
Disp. No..
Week 1
Week 2
Week 3
Week 4
Week 6
Week 8
6 Months
1 Year
Results
Poor
Fair
Good
Excellent
Occupational Therapy Yes No
Limitation (%) and Deformity at discharge
SUMMARY
1. As a result of the unsatisfactry results in the treatment of severed tendons, a
need is seen for the accurate tabulation of techniques. It is believed that by accurate
analysis of records and follow-up data, more satisfactory procedures will eventually
emerge.
2. A tendon form is presented which is designed to facilitate the precise recording
of methods employed. This form also serves as a means of tabulating follow-up data.
ISLET CELL TUMOR OF THE PANCREAS— Report of a Case Originally
Diagnosed as Post-Partum Psychosis*!
S. EDWIN MULLER, M.D. and JOHN A. SPITTELL, Jr., M.D.
Patients with hypoglycemia may present symptoms referable to disturbances of
the central nervous system, autonomic nervous system, the gastrointestinal tract,
or the cradiovascular system (1). Many authors in the past have noted symptoms of
mental or nervous disturbances in hypoglycemia. Incorrect diagnoses such as epi-
lepsy (2), brain tumor (3), chronic alcoholism (4), encephalitis, neuro-circulatory
asthenia, cardiac neuroses, angina pectoris, peptic ulcer, and mental disturbance
requiring committment to institutions in the past have been made on patients in
hypoglycemia caused by islet cell tumors of the pancreas (5). Whipple and Frantz
state that the most common erroneous diagnoses are epilepsy and alcoholism (6).
The occurrence of post-partum hypoglycemic attack is noted by Campbell et
al. (7). Also, the relationship of hypoglycemic attacks, as a result of islet cell tumors,
to the menstrual cycle has been mentioned by White and Gildea (8), and Campbell
(7), and the possible effect of estrogens on glucose metabolism has been discussed.
CASE REPORT
A 32 year old white female was admitted to Mercy Hospital on August 6, 1950, with a chief
complaint of weak spells during the past seven months.
On January 2, 1950, she gave birth to a full term, living child weighing 7 pounds 12 ounces. The
patient's pregnancy was remarkable only insofar as she had "heartburn" from the fifth to the ninth
month. Labor was essentially uncomplicated, and her post-partum course was normal. She was
discharged from the hospital with her baby on January 7, 1950. The patient stated that her post-
partum course at home was marked by extreme weakness, causing difficulty on arising in the morn-
ing. During her first week at home, her husband called her attention to several peculiar things she
was doing. On January 16, 1950, 14 days post-partum, she awoke in the morning, "wringing wet
with perspiration", and feeling extremely weak. The same occurred on the following morning, but
gradually wore off as the day proceeded. On January 18, 1950, she arose despite her feeling of ex-
treme weakness. She ate no breakfast and about 11 A.M., she fell to the floor from shear weakness.
There were no other symptoms except that she was so confused she could not dial the telephone to
summon aid. On the following day she had a similar experience. On January 20th, 1950, again she
ate no breakfast; and about 11 A.M., in her mother's presence, became confused, fainted, and suf-
fered a convulsion. The patient was then referred to the Mercy Hospital Emergency Room where
she was found incoherent, uncooperative, and had to be restrained. A diagnosis of post-partum
psychosis was made, and she was committed to a mental hospital.
Upon arrival at the mental hospital "the patient was in a semi-comatose state and had froth at
the angles of her mouth." A physical and neurologic examination revealed nothing abnormal, and
the patient awoke spontaneously 3 hours after admission. An electroencephalogram was interpreted
as normal, as was all routine laboratory work except for a fasting blood sugar of 53 mgm. per cent.
Interviews showed the patient's sensorium to be perfect, and her mental status was normal. The
impression was: ' The equilibrium which this obsessive and dependent woman has so far maintained
is upset by the birth of a child; in consequence, she develops hysterical symptoms."
* From the Department of Medicine, Mercy Hospital, University of Maryland School of Medi-
cine.
t Received for Publication December 26, 1950.
174
MULLER AND SP ITT ELL— TUMOR OF PANCREAS
175
During her 25 days of confinement, the patient was symptom-free, but her fasting blood sugar
was constantly low. A three hour glucose tolerance on February 9, 1950, showed a fasting sugar of
63 milligrams per cent, 100 mgm. per cent at one hour, 80 mgm. per cent at 2 hours, and 65 mgm
per cent at 3 hours. The patient was discharged from the mental hospital on February 14, 1950, for
further investigation of the hypoglycemia. During the next 3 months, she showed constantly low
fasting blood sugars and was treated by a high protein diet and frequent feedings. Six hour glucose
tolerance curves on March 17, 1950, and July 7, 1950, showed very low fasting and final blood
sugars (See Figure 1). She remained symptom-free until July 4, 1950, when she became extremely
confused but was immediately relieved by a cola drink. Because of her continued weakness and
apparent lack of response to a high protein diet, the patient was hospitalized.
A family history showed that the patient's mother had died of carcinoma of the breast. Her past
history was negative except for a cervical biopsy in 1947 for intermenstrual bleeding. The review of
systems was essentially negative with no evidence of previous hypoglycemic attacks. A physical
170-1
BLOOD
SUGAR l6°-
MGM%
150 H
GLUCOSE TOLERANCE CURVE
ON 3-17-50
ON 7-7-50
— ON 8-7- 50
y2 ■
TIME IN HOURS
Fig. 1. Glucose tolerance curves
examination on admission to the hospital showed a well developed and nourished white female in
no distress. Her blood pressure was 120 mm. mercury systolic and 76 mm. mercury diastolic. The
remainder of the physical examination was within normal limits.
Laboratory studies showed normal hematologic aspects. An abnormal solute eosinophile count was
222 per cubic millimeter. The urinalysis was normal; blood urea was 23 mgm. per cent; cholesterol
210 per cent; Kahn test for syphilis was negative; sedimentation rate was 12 mm. per minute,
corrected; stool examination was negative for blood ova or parasites. Fasting sugars were 65 mgm.
per cent on August 7, 1950, and 76 mgm. per cent on August 8, 1950. A 6 hour glucose tolerance
test on August 7, 1950, is shown in Figure 1. Skull and chest roentgenographs were negative. Basal
metabolic rate was within normal limits.
The patient's clinical course, the repeatedly abnormal glucose tolerance tests with fasting blood
sugars below 50 mgm. per cent, the absence of evidence of liver, thyroid, pituitary, or other diseases
causing hypoglycemia; and her failure to respond to conservative management with high protein,
176
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
low carbohydrate diet; were considered indication for surgical exploration for an islet cell tumor of
the pancreas.
On August 13, 1950, under spinal anesthesia, an operation was performed by Dr. H. H. Burns.
A small tumor, about 1 centimeter in diameter, was removed from the lower border of the pancreas
at the junction of the head and body. During the operation, she was given 5 per cent glucose in nor-
mal saline, intravenously, at a continuous rate. Blood sugar studies during the operation seemed to
indicate an insulin content of the tumor (see Figure 2). Her post-operative course was essentially
Fig. 2. Blood studies during operation
a. Immediately preoperative
b. During operative exposure of pancreas
c. Immediately after manipulating and removing tumor
d. Immediately after closing skin
e. 2\ hours postoperative
f. 3§ hours postoperative
uncomplicated, and blood sugar studies showed fasting levels from 94-144 mgm. percent. On August
22, 1950, a 6 hour glucose tolerance curve Was normal (Figure 3).
The pathologic report by Dr. W. C. Merkel was as follows: Gross: A round tumor 1 cm. in diam-
eter. Microscopic: The section presents an area composed of polyhedral cells made up of a mixture
of basophilic and fasciculated cells. The cells are quite uniform in morphology and have a tendency
to group around vascular sinusoids, and this alignment is so close to the endothelium that it is diffi-
cult to separate the sinusoids from the alveoli. There is a marked increase in the vascularity and
variation in the sinusoids, some of which are extremely large and distended with well preserved
red cells. The nuclei and cells are uniform in shape. There is no encapsulation, but very careful
displacement of adjacent pancreatic parenchyma can be demonstrated. The surrounding parenchyma
MULLER AND SPITTELL— TUMOR OF PANCREAS
177
presents normal pancreatic tissue, including well preserved islands of Langerhans. There is no
inflammatory reaction. Diagnosis: Islet cell adenoma of the pancreas.
BLOOD
SUGAR
MGM%
I 2 3
TIME IN HOURS
Fig. 3. Six hour glucose tolerance nine days after operation
Recently, Crain and Thorn (9) tabulated all of the reported cases of islet cell
tumors of the pancreas. The following signs and symptoms were found in patients
with islet cell tumors and tabulated as follows (9).
1. Loss of consciousness 58%
2. Confusional state •. 54%
3. Weakness and fatigue 41%
4. Deep coma 40%
5. Sweating £■% . 36%
6. Drowsiness and stupor . 35%
7. Light headedness 30%
8. Visual disturbance. . . . 30%
9. Amnesia 28%
10. Clonic convulsions 24%
1 1 . Noisy behavior 20%
12. Headaches. 20%
13. Tremor . 18%
14. Hunger 14%
15. Positive Babinski 13%
16. Paresthesias 13%
17. Irritability . 11%
18. Transient hemiplegia 10%
19. Abdominal pain 8%
20. Palpitation : 3%
The tabulation of the distribution of insulomas by Crain and Thorn (9) is also of
importance (Chart I). Differences of opinion have existed as to the distribution of the
tumor. One case (13) of total pancreatectomy has been reported in which the tumor
could not be found at operation. A very small tumor was found in the head of the
178
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
';3
ffWgffg^&£g&ra?*'
M
Fig. 4. Photomicrograph of tumor
a. Low power photomicrograph of tumor growth, (Top) showing thin capsule surrounding the
adjacent compressed pancreatic tissue.
1). High power photomicrograph, (Bottom) showing details of tumor cells.
removed gland. Chart I shows the chances of serious error in total pancreatectomy
for an islet cell tumor that cannot be found at operation.
MULLER AND SPITTELL— TUMOR OF PANCREAS
179
6 ABBERENT PANCREAS
BENIGN INSULINOMAS
I ABBERENT PANCREAS
MALIGNANT INSULINOMAS
Chart I. Location of reported benign and malignant insulinomas
The causes of spontaneous hypoglycemia are many. The following excellent
etiologic classification has been listed by Conn (10).
I. Organic — recognizable anatomic lesion
A. Hyperinsulinism
1. Pancreatic island cell adenoma
(a) Single
(b) Multiple
(c) Aberrant
2. Pancreatic island cell carcinoma
(a) Localized
(b) With metastases
3. Generalized hypertrophy and hyperplasia of the islands of Langerhans
B. Hepatic disease
1. Ascending infectious cholangiolitis
2. Toxic hepatitis
3. Diffuse carcinomatosis
4. Fatty degeneration of "fatty metamorphosis"
5. Glycogenosis (von Gierke's disease)
C. Pituitary hypof unction (anterior lobe) . .
1. Destructive lesions (chromophobe tumors, cysts)
2. Atrophy and degeneration (Simmons' disease)
3. Thyroid hypofunction (? secondary to pituitary hypofunction)
D. Adrenal hypofunction (cortex)
1 . Idiopathic cortical atrophy
2. Destructive infectious granulomas
3. Destructive neoplasms
E. Central nervous system lesions (hypothalamus of brain stem; interference with nervous
control of blood sugar)
II. Functional — no recognized anatomic lesion but explainable on basis of unusual somatic function
A. Hyperinsulinism (imbalance of the autonomic nervous system): hypoglycemic fatigue;
nervous hypoglycemia; functional hypoglycemia; reactive hypoglycemia
B. Alimentary hyperinsulinism (rapid intestinal absorption)
1. After gastroenterostomy
2. After gastric resection (partial or total)
180
BULLETIN OF THE SCHOOL OF MEDICINE, V. OF Ml).
C. Renal glycosuria (severe degrees of low renal threshold for dextrose)
D. Lactation
E. Severe continuous muscular work
III. Miscellaneous
A. Factitious (surreptitious insulin administration)
B. Postoperative hypoglycemia
C. Severe inanition
D. Unknown
Conn (10) states that more than 80 per cent of the cases of hypoglycemia are
caused by one of the following: 1) Functional hyperinsulinism, 2) Organic hyper-
insulinism, 3) Hepatogenic hypoglycemia. Hepatogenic hypoglycemia is usually not
difficult to differentiate clinically. The differentiation of functional and organic hy-
perinsulinism may be more difficult. Figure 5 from Conn (10) gives the usual glucose
220
BL00D 200 H
SUGAR
mg/.oocc j80 _
160 -
140 -
120 -
100 -
80 -
60 -
40 -
20
0
/GLYCOSURIA \
I
•HEPATOGENIC
HYPOGLYCEMIA
NORMAL
iFUNCTIONAL
HYPERINSULINISM
ORGANIC
HYPERINSULINISM
HOURS
Fig. 5. Dextrose tolerance curves in spontaneous hypoglycemia (3 types)
tolerance curves found in these conditions. The outstanding differences are apparent.
Organic hyperinsulinism shows a fasting sugar below 50 mgm per cent. The curve
usually is low, returning to hypoglycemia levels in 5 to 6 hours and remaining low.
This is not always true as shown by this case and others. The functional hypogly-
cemia curve typically begins with a normal fasting sugar but falls to hypoglycemic
levels in 2 to 3 hours. The hepatogenic type typically shows a low fasting sugar
followed by a curve of the diabetic type. The tolerance tests are not always reliable,
and all three types of curves have been reported in the presence of islet cell tumors
(11). Many factors influence the glucose tolerance curve (2), limiting the value of this
test in differential diagnosis. Furthermore, Duff (12) reported that only 64 of 90
islet cell tumors were functioning clinically.
It is generally agreed, however, that in the absence of other organic disease causing
hypoglycemia, a blood sugar, after a prolonged fast of less than 50 mgm per cent,
MULLER AND SPITTEL— TUMOR OF PANCREAS 181
is the best criterion for the diagnosis of an islet cell tumor and differentiation of
functional hypoglycemia.
SUMMARY
A case of an islet cell tumor of the pancreas, originally diagnosed as post-partum
psychosis, is presented. Surgical removal of the tumor effected a complete cure.
The continuous administration of glucose during the operation in this case seemed
important in that the blood sugar fell to hypoglycemic levels when the tumor was
manipulated in spite of continuous administration of glucose.
BIBLIOGRAPHY
1. McClure, Roy D., and Brush, Brock E.: Experience with islet cell tumors. Arch, of Surgery.
59: 507, 1949.
2. Perkins, Herbert A., Destorges, Jane F., and Gtjttas, Charles G.: N. E. J. of Med.,
243: 281, 1950.
3. Friedman, N. B.: Chronic hypoglycemia — Report of 2 cases with islet cell adenoma and changes
in the hypophysis. Arch. Path., 27: 994, 1939.
4. Murphy, Robert G., Dustin, Cecil C, and Bowman, Russell O.: Hyperinsulinism due
to adenoma of the pancreas. J. of Lab. and Clin. Med., 24: 1050, 1939.
5. Malamud, N. and Grosh, L. C, Jr.: Hyperinsulinism due to islet cell adenoma of pancreas
with destruction of cerebral cortex — Preliminary report. Univ. Hos. Bull. Ann Arbor, 3:
70, 1937.
6. Whipple, Allen O., and Frantz, Virginia Kneeland: Adenoma of islet cell with hyper-
insulinism. An. of Surg., 101: 1299, 1935.
7. Campbell, Walter R., Graham, Roscoe R., and Robinson, William L.: Islet cell tumors of
the pancreas. Am. J. Med. Sci., 198: 445, 1939.
8. White, Benjamin V., and Gildea, Edwin F.: Adenoma of the pancreas and hyperinsulinism.
N. E. J. Med., 217: 307, 1937.
9. Crain, E. L., and Thorn, G. W.: Functioning pancreatic islet cell adenomas. Medicine, 28:
427, 1949.
10. Conn, J. W.: Spontaneous hypoglycemia. J. A. M. A. 134: 130, 1947.
11. Tedstron, M. K.: Hypoglycemia and hyperinsulinism. An. Inter. Med., 7: 1013, 1934.
12. Duff, A. L.: Pathology of islet cell tumors of pancreas. Am. J. Med. Science, 203: 437,
1942.
13. Priestly, James T., Comfort, Manfred W. and Radcliffe, James, Jr.: Total pancreatec-
tomy for hyperinsulinism due to an islet cell adenoma. Ann. Surg., 119: 211, 1944.
EDITORIAL
LIMITING FACTORS IN THE USE OF ANTIBIOTICS
The writer of the book of Ecclesiastes very cogently wrote: "The thing that hath
been, it is that which shall be; and that which is done is that which shall be
done; and there is no new thing under the sun." Although we have used the anti-
biotic drugs for only a decade, the basic concept of their use is centuries old. The
ancient Greeks used warm soil to promote healing. The Servian peasants for centuries
employed molds in the treatment of wounds. In 1760 in The Old English Herbals
it was noted that molded bread was useful in facilitating the healing process in
wounds. But during the last decade the use of the antibiotic drugs has made a mo-
mentus impact upon the medical practice.
The extent to which the antibiotic drugs are used is reflected in the volume of
their industrial production, which now outranks that of all other medicinals. It has
been estimated that in 1948 penicillin and streptomycin alone accounted for more
than one-half of the total of manufacturer's income from the sale of synthetic
drugs. This figure is especially impressive when it is realized that penicillin first
became available commercially in 1943 and that streptomycin was not offered for
sale until two or three years later. Sufficient time has elapsed for us to review with
significant retrospection the deleterious results which have been encountered in the
administration of the antibiotics.
Nearly all substances which are employed as drugs produce some type of un-
desirable side reaction. The nature and severity of these untoward effects must
always be weighed against the value of the drug as a therapeutic agent in any
disease condition. Indeed the antibiotics as a class are comparatively free from
permanent damaging side effects when considered in the light of their therapeutic
efficacy. Undesirable side effects do occur and in general they may be evaluated
under the following headings:
1. DEVELOPMENT OF RESISTANCE BY BACTERIA
The appearance of resistant strains of microorganisms is a definite epidemiologic
problem posed by the use of penicillin. For example, bacterial strains of staphylococci
collected from random patients in 1943 showed a greater sensitivity to penicillin
than those collected from random patients in 1949. The treatment of tuberculosis
with streptomycin has always presented the problem of the emergence of resistant
strains. Indeed it appears that the use of antibiotic drugs in conditions which can
be adequately and successfully treated by other chemotherapeutic agents tends to
promulgate the emergence of resistant strains of various organisms to the cur-
rently used antibiotic agents.
2. SUPERINFECTIONS
A frequent complication in antibiotic therapy is the appearance of a second
infection in patients under treatment for a primary infection. These superinfections
are more likely to occur when very young, very old, or debilitated patients are
182
EDITORIAL 183
being treated. For example, staphylococcic glossitis and pharyngitis may occur
during streptomycin therapy. When Aureomycin, Chloramphenicol or Terramycin
are being given, monilial infections of the mouth, tongue and vagina may occur.
The black-tongue which may occur during penicillin therapy is probably caused by
a secondary invader. Pneumonias caused by gram-positive rods sometimes make
their appearance while penicillin is being administered. It is possible that proteus
may displace other organisms in urinary tract infections which are being treated
with Aureomycin, Terramycin and occasionally Chloramphenicol.
3. DIRECT TOXIC EFFECTS
In the main the toxic effects of the antibiotic drugs are few. It is well established
that vertigo and deafness may result from the injury of the eighth cranial nerve
during streptomycin therapy. Chloramphenicol is reported to have produced leuko-
penia, granulopenia and anemia in a few patients. Instances, however, are extra-
ordinarily rare. Penicillin, but notably Aureomycin, Terramycin, and to a lesser
extent Chloramphenicol, produce gastrointesintal symptoms when administered by
mouth. In many patients these symptoms are disconcerting and extend over con-
siderable periods of time. Polymyxin, Neomycin and Bacitracin have been known to
produce definite kidney damage.
4. HERXHEIMER REACTION
Occasionally when patients have been treated with penicillin for syphilis, primary
reactions have resulted. Some fatalities have been reported in patients with cardio-
vascular syphilis treated with penicillin. It is deemed most prudent to use bismuth
first in those cases of syphilis with aneurisms or extensive aortitis.
Thus it becomes quite clear that although the antibiotic drugs have scored a
shining mark of success in the conquest of the infectious diseases, their promiscuous
use and unwarranted administration to patients are not without repercussions both
from the point of view of the epidemiology of disease and the patient's general
comfort.
John C. Krantz, Jr., Ph.D.
CLINICO-PATHOLOGIC CONFERENCE
From the Case Histories, University Hospital, Baltimore
CLINICAL HISTORY
In June of 1950 a 21 year old white female who had lost 35 pounds first noticed the
onset of anorexia, fatigability, shortness of breath and a non-productive harassing
cough. It was considered that a vacation might help her, so she and her husband
took a lengthy motor trip. Since her symptoms showed a steady progression, and
because of the cough, she consulted her family physician. Following a roentgenograph
of her chest, reported as "suspicious", she went to a state tuberculosis detection
center. There, the chest films were repeated and extensive studies were performed on
her sputa. However, mycobacteria were not demonstrated. She was then referred
to the University Hospital for further study and treatment. At the time of admission,
she had lost approximately 35 pounds in weight.
Her health had been good until the present illness. She had had no serious illnesses,
operations or injuries. She had shortness of breath with upper respiratory infections
and swelling of feet and legs after prolonged standing. She offered no history indicative
of rheumatic fever.
On admission to the hospital her temperature was 97.8 F. ; pulse rate, 84 per minute;
respiratory rate, 20 per minute; and systolic and diastolic pressures, 118 and 70
millimeters of mercury. The patient was described as a well developed, well nourished
21 year old white female lying quietly in bed. Her color was good. She had a frequent
dry, hacking cough. In spite of the 35 pound weight loss, she was described as rather
large. There were striae present over the hips. No abnormalities of the head, eyes,
nose, mouth or throat were noted. There was a firm, discrete, freely movable non-
tender node in the right posterior cervical chain which was the size of a lima bean.
There was a similar node in the right femoral region. Aside from small, shotty
inquinal lymph nodes there was no other significant lymphadenopathy. The thyroid
was not palpable. The trachea was in the midline. Both lungs expanded well and
were resonant to percussion. The breath sounds were bronchovesicular. There were
rales at both lung bases. The heart was normal. An examination of the abdomen
revealed a greatly enlarged spleen, extending 5 cm. below the costal margin and a
firm non-tender liver which extended about 2 cm. below the right costal margin.
The remainder of the examination was negative. Roentgenographs were made of the
chest (Fig. 1) and hands.
The urine was straw colored, acid and devoid of albumin, sugar, casts and blood
cells. An examination of stool specimens was negative. There were no skin responses
to tuberculin, purified protein derivative, brucallergin, coccidiodin, or histoplasmin.
The blood hemoglobin concentration was 14.5 grams or 100 per cent. An hemogram
included an erythrocyte count of 5.95 million; a blood volume of 44; an erythrocyte
sedimentation rate of 18 millimeters per minute; and a leucocyte count of 6000 cells
per cubic millimeter. Sixty-nine per cent of the white blood cells were neutrophilic
polymorphonuclear granulocytes; 25 per cent, lymphocytes; 1 per cent, monocytes;
184
CLINICO-PA THOLOGIC CONFERENCE
185
and 5 per cent, eosinophilic granulocytes. The blood mean corpuscular volume,
hemoglobin, and hemoglobin concentration were 74, 24, and 33, respectively. The
bleeding time was 2 minutes and 30 seconds. The clotting time was 6 minutes and 3
seconds. The blood contained 16 milligrams of urea nitrogen in each one hundred
cubic centimeters and 82 milligrams of glucose. Total serum proteins were determined
to be in concentration of 9.74 and 9.90 grams per hundred cubic centimeters. The
serum globulin was definitely elevated in each determination. Each 100 cubic centi-
meters of blood contained 223 milligrams of cholesterol; .3 milligrams of direct
bilirubin, .1 milligrams of indirect bilirubin, 9.7 milligrams of calcium, and 3.9
Fig. 1. Roentgenograph of chest showing extensive shadows in both lungs
milligrams of phosphorus. The alkaline phosphatase was reported in concentration
of 1.26 units per 100 cubic centimeters of serum. Thymol turbidity was reported as
12.9 units. There was no retention of bromsulphaline. The basal metabolic rate was
accelerated 40 per cent. The serologic test for syphilis was negative. Agglutinins for
Brucella, Pasteurella, Eberthella, Salmonella and Rickettsia were negative. There
were no Mycobacteria in the gastric washings.
The patient was completely afebrile during her entire stay. On the 15th of No-
vember a sternal puncture was done and marrow was obtained for guinea pig inocu-
lation and culture on Sabaroud's medium for fungi. On the 15th of November a liver
biopsy was obtained by aspiration. On November 22 a node in the right femoral
region was removed for microscopic study. She gained 3 pounds during her hospital
stay and was discharged improved on the 27th hospital day.
186 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
CLINICAL DISCUSSION
Dr. Alex Murphy: I notice that there is a fairly meticulous geographic study of her
holiday, but I feel that this really is not relevant because it was after she developed
her symptoms that this trip was taken.
I find the basal metabolic rate very difficult to reconcile with the clinical aspects.
Forty per cent is quite an increase, and yet this woman had a pulse of 84, was lying
quietly in bed, had no evidence of cardiac failure and had no thyrotoxicosis. There-
fore, I challenge the accuracy of this figure.
I would divide this problem into two phases. First, this young woman with no
significant story in her past, who was obviously too fat and overweight, complained
of fatigability, some weight loss, shortness of breath and a non-productive harassing
cough. Quite naturally, tuberculosis was suspected and roentgenologic studies were
made, which resulted in the discovery of abnormal shadows in the lungs. These
shadows confirmed, to some extent, the suspicion of the physician and extensive
studies of the sputum were made. These failed to reveal the presence of M. tubercu-
losis. At that time there was a search made for fungi, and none of the ordinary fungi
were discovered. The patient apparently continued to lose weight and came into the
hospital on October 30, some 5 months after the onset of her illness. At that time,
she showed some signs in her lungs — post-ptussic rales, rales at both bases, a palpable
node in the neck and in the groin , a very large spleen and a considerable hepatic
enlargement. She was still described as "fat." There was a tendency to erythrocytosis.
I would rather attribute that to some physical difficulty because of interference with
gaseous exchange in the lungs. This is not adequately explained by tuberculosis. It
is unusual to find signs at both bases in patients with early tuberculosis. While her
spleen might have been enlarged in a miliary form of tuberculosis, she does not
present the clinical aspects of miliary tuberculosis. Even after 5 months her cough
was non-productive. A tuberculin test was negative. I have seen negative tuberculin
tests in people who are overwhelmed with a miliary tuberculosis, but again the
impression that one gets from this case is not that of a desperately ill patient . She
was afebrile and her pulse rate was not increased. With the condition presented on
her admission to the hospital, I would seek the agent which could be responsible for
lung lesions, lymphadenopathy, liver and splenic enlargement and with changes in
her plasma proteins. One of the first things that enters one's mind, of course, is the
lymphomas. Hodgkin's disease might deserve consideration. However, the signs and
symptoms in this patient are not characteristic of Hodgkin's disease. I cannot
believe that the results of her blood tests would have been as they were, nor would
she have a complacent countenance had she been alarmingly ill. I believe a relatively
benign process caused all those signs and symptoms. Furthermore, we note that the
patient gained a little weight during her hospital stay. The plasma protein was
negative. We do get an increase in globulin in tuberculosis, but the only persons in
whom I have observed that were those with a long-standing disease, so I really
believe tuberculosis might be eliminated. Also, plasmacytosis or multiple myeloma
cause an increase in the plasma protein, but once again I think that the blood count
would be against this.
I notice that a sternal marrow puncture was performed and suspect that plasma
cells were not found. I haven't seen them in brucellosis. Kala-azar can be dismissed.
CLINICO-PATHOLOGIC CONFERENCE 187
There is one condition which to me seems capable of providing an adequate explana-
tion of the whole condition, and that is sarcoid. Sarcoid is responsible for enlarge-
ment of lymph nodes and very frequently it causes lung changes which might be
interpreted as tuberculosis. It will also lead to enlargement of the spleen and liver.
The plasma protein is usually elevated in sarcoid, and, not infrequently, the calcium.
The fact that the calcium is not elevated does not deter me in suggesting that sarcoid
appears the most likely explanation to me. I notice that in spite of a liver biopsy, a
node was removed some days later. It was suggested that the information coming
from the liver biopsy was not satisfactory to the pathologist. I am rather disturbed
by the sternal puncture and cultures which made me wonder if brucellosis can
produce this syndrome. However, the agglutinations were negative. Therefore, tu-
berculosis is disproved; brucellosis does not appear to be the diagnosis; and Hodgkin's
disease is dismissed because the patient does not appear ill enough. I am more or
less left with sarcoidosis as my diagnosis.
Dr. Walter Kilby: We have two sets of roentgen films. One set was made on ad-
mission and the other about two weeks later.
Dr. Murphy: If I were seeing the films without knowing anything about the case,
the three things that would be suggested would be carcinomatosis, miliary tubercu-
losis, or sarcoid. I have had no experience whatsoever with histoplasmosis. I cannot
see the glandular enlargement that I would expect in sarcoidosis. I still "stick" to
my diagnosis of sarcoidosis.
Dr. Kilby: We were quite amazed when we saw these roentgenograms, and also
quite bewildered. The very numerous lesions extend throughout both lungs. The
fine patches of infiltration are almost equal in size. Although we attempted to relate
the film characteristics with many diseases, we were unable to draw any conclusions.
We were quite bewildered until we heard a report of the biopsy.
PATHOLOGIC DISCUSSION
Dr. Hugh R. Spencer: The diagnosis in this case was made on the basis of biopsy
material. The first specimen was obtained by aspiration from the liver. In the sections
made from this tissue there were several small closely approximated, though discrete,
lesions composed of large vacuolated cells of the epithelioid type. There was rela-
tively little reaction in the surrounding liver tissue. Appropriate stains failed to
reveal acid-fast organisms. The lesion was reported as granulomatous in character,
probably sarcoidosis.
The second specimen was a lymph node removed from the right femoral region. In
this node the structure was considerably distorted and much of the lymphoid tissue
was replaced by small, well-circumscribed masses of epithelioid cells. The cells
appeared somewhat vacuolated and in the centers of some of the lesions giant cells
of the Langhans' type were noted. A few of the giant cells contained asteroid bodies.
None of the lesions showed central caseation. These sections presented aspects
typical of sarcoidosis.
Sarcoidosis is a generalized systemic condition characterized by tubercle-like
lesions. The organs most commonly affected are the lymph nodes, lungs, spleen, skin,
short bones of fingers and toes, uveal tract and the salivary glands.
Boeck in 1899 published simultaneously in Norway and in the United States a
188 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
report of some apparently rare skin lesions that have since come to be associated
with his name. The bluish nodules and infiltrating lesions of the skin, he interpreted
as sarcoma-like and hence applied the name sarcoid to the condition. The name
sarcoidosis has been retained in this country, but in Europe the disease is commonly
referred to as benign lymphogranulomatosis.
The skin lesions of Boeck are only one of many regional manifestations of the
disease. Much confusion of terminology has resulted from the fact that a number of
syndromes based upon the particular organs involved were described. Lupus-pernio
of Besnier, osteitis tuberculosa multiplex cystica of Jungling, and uveo-parotid fever
of Heerfordt which were originally described as singular syndromes are now known
as sarcoidosis.
Sarcoidosis, once considered a rare curiosity of interest chiefly to the dermatologist,
is now known to be relatively common. Well over 1000 cases have been reported.
The disease is encountered in all parts of the world, with apparent prevalence in
the cooler countries, especially in Scandinavia. It is difficult to make even an ap-
proximation of the actual incidence. With recruits in the Swiss Army the incidence
is given as 0.13 per thousand. Figures in Denmark are about the same.
Sarcoidosis has been reported in the extremes of age, but probably more than half
of the patients present evidence of the disease before the age of thirty and two-thirds
before the age of forty.
In this country an unusually high incidence has been noted among Negroes. In a
group studied in Philadelphia, eighty per cent of the patients were Negroes and in
an Army Hospital Group the incidence for Negroes was fifty per cent. All of these
figures are higher than the proportion of Negroes in the general population.
In sarcoidosis the lesions in all tissues are the same. They consist of small cellular
tubercles, composed of large pale epithelioid cells with or without giant cells. The
lesions are discrete, they show the same stage of development, there is little or no
caseation necrosis and little or no surrounding collar of lymphocytes. The giant cells
may be either typical Langhan's or of the large foreign body type. Some of the
giant cells may contain asteroid, radial, or laminated inclusion bodies. These, how-
ever, are not pathognomonic since they have been described in the giant cells of
leprosy, torulosis, beryllium lesions and in foreign body granulomas.
Little is known about the development of the lesions. They are thought to begin
in perivascular tissues with a deposition of lymphocytes, to be replaced later by
epithelioid cells. They may persist in characteristic form for indefinite periods.
Resolution or scarring appear to be their ultimate fates.
The lesions have been found at one time or another in practically all organs of
the body. The lymph nodes are involved in fifty to seventy-five per cent of cases.
The intrathoracic nodes are those most consistently affected. The lymph nodes
remain discrete. The enlargement is rarely associated with pressure and obstructive
phenomena. The tonsils are commonly involved in this disease. The spleen appears
to be frequently involved. In one series of 29 cases collected from the literature,
splenic lesions were noted in 21. The weight of the spleen in this disease may oc-
casionally exceed 1000 grams. Hypersplenism has been described in cases with
splenic involvement. Lesions in the liver occur only slightly less often than in the
spleen. Hepatomegaly may be marked. In a number of cases (as in this case) the
CLIN I CO-PAT HO LOGIC CONFERENCE 189
diagnosis has been suggested as result of study of aspiration biopsy from the liver.
Involvement of the pulmonary parenchyma is often a prominent feature of this
disease. There may be extensive involvement in the complete absence of symptoms.
The lesions as seen with the aid of roentgen rays may be miliary in type or they may
show a linear distribution. Active pulmonary tuberculosis is said to supervene in
about 10 per cent of the cases. In the recorded autopsies the heart and kidneys are
involved in about 20 per cent of the cases. Hypercalcemia and renal calculi are
occasionally encountered. Bone is involved in 15 to 25 per cent of the cases. The
lesions are cystic or cystoid areas of medullary rarefaction which are more commonly
encountered at the short bones of the hands and feet, but similar lesions have been
demonstrated in the long bones and in the vertebrae. Lesions in the skin and mucous
membranes occur in about one-half of the cases. The skin lesions may be miliary,
nodular or diffuse plaque-like. Healing may leave no residue or may result in a
pitted scar. Eye involvement occurs in 25 to 50 per cent of the cases producing iritis
and irido-cyclitis. Uveitis may be associated with enlargement of the salivary glands,
especially the parotid. The tuberculin reaction is negative in from 60 to 70 per cent
of the cases. The Kveim test which has been found to be positive in a fair percentage
of patients with active sarcoidosis, is a recent development. In this test the intra-
dermal injections of extracts of sarcoid material produce characteristic skin lesions in
patients with active sarcoidosis. The reaction appears to be rather specific, but the
antigen is much less so. Extracts of normal human spleens, of lymph nodes in lymph-
oid leukemia, tubercle bacilli and other substances may produce characteristic lesions
in active sarcoid cases.
The cause of the disease is not known. The tubercle bacillus and an unknown
agent, perhaps a virus, remain the most favored possibilities.
DISCUSSION
Dr. Murphy: Might I ask the explanation of the 40 per cent basal metabolic rate?
Dr. T. Nelson Carey: I felt that the high metabolic rate was caused by respiratory
insufficiency. Her respiratory rate was much more active than one would expect
considering her apparent good health. The clinical problem was mainly to exclude
miliary tuberculosis.
Dr. M. C. Pincoffs: There are just one or two comments I would like to make.
Before convening here, Dr. Murphy asked me if we have used ACTH in sarcoidosis.
We have done so in one case of uveo-parotid fever showing very serious eye involve-
ment. The majority of cases with uveo-parotid fever regress after a long course, but
not only was this woman losing her eyesight, her general condition was alarming
and furthermore was deteriorating rapidly. I have seen her once since ACTH was
given. In my opinion, there were no beneficial effects, even though there was slight
regression in the ocular lesions. While this case, under discussion, had obvious
dyspnea, it is astounding how many cases of sarcoid occur without impairment of
respiratory function. A physician from Washington was admitted here because of
opacities in a roentgenogram of his chest. He had extensive bilateral, doom-portending
bands of infiltration throughout the lung parenchyma. Nevertheless, he had lost
comparatively little weight, and there was no breathlessness.
One other point I would like to comment on is in connection with granulomata of
190 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MB.
the liver. Dr. Klatskin, whom I heard at Yale speak on granulomata of the liver,
was particularly interested in sarcoid and generally interested in other granulomatous
conditions that may be diagnosed by liver biopsy. He took the entire core from the
needle which he had used for his aspiration and serially cut the entire specimen.
That, of course, is a very laborious process. He had punctured a great many cases of
tuberculosis that did not have apparent liver involvement and found in them a high
percentage of minute granulomatous lesions. Some of the lesions showed caseation.
In only one, could he find Mycobacteria. He offered 600 cases in which liver biopsies
had been done and in only four were granulomata found. He found liver granulomas
in a high percentage of sarcoid, a fair percentage in tuberculosis and lymphoma, and
very rarely in conditions in which there was no indication for making a liver ex-
amination. But when he came to comparing the histology of the granulomata, he
found he could not make any distinction. He could not tell sarcoid from tuberculosis
except when tuberculosis had reached an advanced stage, and had its typical mantle
of surrounding cells and caseation in the center.
OBSTETRICAL CASE REPORT
From tlie Department of Obstetrics, University of Maryland School of Medicine
M. E., a 23 year old para 0-0-0-0 was first seen September 18, 1950, in consultation.
Her past and family histories were non-contributory and the pregnancy had reached
the 36th week without difficulty. She had just been admitted to the contagious
ward after an illness at home of 3 days duration. The medical diagnosis was bulbar
spinal poliomyelitis. Her temperature was 102 F, the spinal fluid white blood cells
numbered 750 per cubic millimeter with 60 per cent polymorphonuclear neutrophils.
The respiratory ventilation meter registered a vital capacity of only 500 cc. (normal
2500 to 3000). It was the opinion of the internist that this patient should in the
very immediate future have a tracheotomy performed and be placed in a respirator.
It was his opinion that cyanosis, respiratory distress and death would ensue if this
were not done.
Question: What should the obstetrical treatment be under these circumstances?
Discussion: Until quite recently it was believed, taught and felt that any inter-
ference with the pregnancy in cases of anterior poliomyelitis was absolutely contra-
indicated and would result in infinitely more harm than good. This is probably true
in the majority of the cases, the exceptions being the occasional patient as pictured
above: viz; pregnancy near term in a patient suffering from poliomyelitis with bulbar
involvement. In this small group the additional respiratory embarrassment incident
to the enlarged uterus may be enough to tip the balance of the scales against the
individual. It is in this group, and in this group alone, that there is any justification
for promptly emptying the uterus. Time is of the essence here and the abdominal
route should be chosen. This may sound like rank heresy to many, and a few years
ago it would have been heresy, but with the liberal use of the antibiotics, many of
the dangers of the operation have been eliminated and the actual results have
improved. If the patient can be delivered before cyanosis and respiratory distress
have developed and before tracheotomy has been done, the operation is simpler
and the results better. On the other hand, in those who have already been placed in
a resuscitor and tracheotomized and who continue to show increasing distress, the
improvement following section is often most dramatic. The anesthetic of choice
appears to be cyclopropane in a closed system with positive pressure.
Actual treatment and result: A laparotrachelotomy was done without difficulty.
The baby, weighing 2375 grams required a moderate amount of resuscitation. Follow-
ing operation, a tracheotomy was done and the patient was placed in a respirator.
She remained in the apparatus for several months and gradually recovered. The
baby did well.
The Reader is referred to an excellent and comprehensive article by Paula Horn
in the February 1951 issue of The Annals of Western Medicine and Surgery.
191
INDEX TO VOLUME 36—1951
Blair, Emil, 133
Book Reviews, 44, 45, 100, 101, 142
Bradley, J. Edmund, 86
Brantigan, Otto C, 57, 133, 152, 171
Bubert, Howard M., 115
Cancer detection and therapy, II. Methods of
preparation and biological effects of
metallo-porphyrins.
method 1, 3
method 2, 4
Carr, C. Jelleff, 48
Clinico-pathologic conferences, 38, 92, 137, 184
Cortisone, the effect of, in the treatment of
typhoid fever, 143
Culver, Perry J., 48
Demarest, Elinor W., 8
Diagnosis and treatment of the acute abdomen,
103
principles of treatment in the acute abdomen,
106
inflammation, 107
appendicitis, 107
acute gall-bladder disease, 109
perforation, 110
perforated sigmoid diverticulum, 111
intestinal obstruction, 112
mesenteric thrombosis, 114
summary, 114
Editorials 1, 47, 182
Fasciae and subperitoneal fascial spaces of the
male pelvic cavity, 60
parietal endopelvic fasciae, 60
neurovascular sheaths, a reality, 61
line of anchorage, 61
general appearance of neurovascular sheaths,
63
superior hypogastric wing, 65
retrovesical space, 72
the space of retzius, 81
the retrorectal space, 82
Ferguson, L. Kraeer, 103
Figge, Frank H. J., 3
Finesinger, Jacob E., 163
Globin insulin with zinc in diabetic outpatients,
156
Gout — recent advances, 126
Intrathoracic structures, a viable pedicle graft
for repairing, 152
Islet cell tumor of the pancreas, 174
Jackson, Robert L., 24
Jennings, Erwin R., 119, 171
Jones, Chester M., 48
Krantz, John C, Jr., 48, 182
Lenticulo-striate artery, 8
cases of rupture, 12
survey of textbooks, 12
summary, 13
Link, Harwood V., 16
Manganiello, Louis O. J., 3
Mansberger, Arlie R., Jr., 119
Muller, S. Edwin, 174
McCabe, Edward S., 126
Medicine, concerning values in, 163
Method of dividing intracardiac structures with-
out opening the heart chambers, 57
Moore, Marcus W., Sr., 24
New type pull-out wire for tendon surgery, a
preliminary report, 119
description, 119
technique, 119
Obstetrics, 28
annual report, 28
case reports, 43, 99, 141, 191
Osteogenic sarcoma arising in Paget's disease
(osteitis deformans) of the calvarium, 19
report of a case, 19
Oster, Robert H., 86
Parker. Robert T., 143
Penicillin in bronchial asthma, 115
Penton, Robert S., 57, 152
Perforation of gastrojejunal ulcer following sub-
total gastric resection for duodenal ulcer, 133
case report, 133
Pericardial coelomic cysts, 24
case report, 24
Proutt, Leah M., 86
Relation between pH changes and rabbit gut
motility in vitro, 86
material, 86
method, 86
Revell, Samuel T. R., 156
Rienhoff, William, Jr., 24
Robinson, Harry M., 16
Robinson, Harry M., Jr., 16
Rodger, Robert C, 19
Shipley, E. Roderick, 86
Smadel, Joseph E., 143
Smith, Edward P., Jr., 119
Spittell, John A., 174
Sugar alcohols-XXVIII. Toxicologic, pharmaco-
dynamic and clinical observations on Tween
80,48
193
194
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
the chemical and physical nature of Tween 80,
48
effect of lipase, 49
toxicology in animals, 49
effect on blood pressure, 50
effect on blood cells, 51
clinical observation and pharmacodynamics
in man, 51
fate of Tween 80 in man, 54
Tendon forms for use in the treatment of severed
tendons, 171
Thompson, Raymond K., 19
Tinea capitis II, studies in the treatment of, 16
nature of drug, 16
clinical studies, 16
method of treatment, 17
results of treatment, 17
Torulosis of the central nervous system: bio-
chemical behavior of the causative organs,
122
introduction, 122
methods, 122
results, 122
discussion, 124
summary, 124
Uhlenhuth, Eduard, 60
Wagner, John A., 19
Wise, Walter D., 2
WToodward, Theodore E., 143
Yeager, George H., 119, 171
MEDICAL SCHOOL SECTION
MEDICAL EDUCATION FUND PROGRESSES
In the May 19, 1951 number of the Journal of the American Medical Association
the leading editorial was devoted to an analysis of the aims, the organization and the
accomplishments of the National Fund for Medical Education and the American
Medical Education Foundation.
Since that editorial, the School of Medicine has received its share of the first dis-
tribution of the more than $1,000,000 already available. These funds have been pre-
sented to the medical schools in the United States through the American Medical
Education Foundation to be used as the school sees fit and without strings attached.
The object of the Fund is to raise from voluntary sources, substantial sums for the
support of the nation's medical schools. $5,000,000 has been set as the annual goal.
Funds are to be solicited not only from physicians but from other sources such as
organized groups and corporations. The soliciting agency for the physician is the
American Medical Education Foundation, organized by the American Medical Asso-
ciation, to which physicians' contributions should be sent.
The National Fund for Medical Education includes contributions from the Amer-
ican Medical Education Foundation. It is a non-profit organization created in 1949
with executive offices at 535 Fifth Avenue, New York 17 New York. The Board of
Trustees and the Advisory Council contain names not only prominent but diversified
throughout the educational and business fields. Thus, lay and professional organiza-
tions are joined in a common endeavor in behalf of the Nation's medical schools.
The financial status of most of the schools of medicine in this Nation today de-
mands additional financial support, if the quality of research and educational op-
portunity is to continue. There can be no financial return from the raising of stu-
dent fees. There can be but two sources of this supplementary income. To a great
measure, each physician can determine the origin of this financial support, for if the
National Fund for Medical Education (and for the physician, the American Med-
ical Education Foundation) is not adequately supported, the only recourse for
funds, from necessity, shall be from governmental sources.
The management of the National Fund for Medical Education in conjunction with
funds from the American Medical Education Foundation, is linked with many well-
known foundations such as the Carnegie Foundation, the Commonwealth Fund, the
Josiah Macy, Jr. Foundation, the Lilly Endowment and the Rockefeller Foundation.
Funds from those foundations have thus far carried the entire administrative costs
of the National Fund, thus making it possible for every dollar collected to flow to the
medical schools.
The National Fund for Medical Education has now been publicly announced. It is
therefore incumbent upon every physician, student and friend of medical education
to encourage repeated, continuous contributions to the effect that the aims and pur-
poses of these foundations shall be currently and continuously achieved.
Physicians should contribute annually to the American Medical Education Founda-
ii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
tion, 535 North Dearborn Street, Chicago 10. Physicians may continue to designate
the school to which they wish their contributions to go.
The furtherance of medical education is an obligation of every physician. The
Alumni and friends of the University of Maryland have thus far been most generous
and realistic in assuming this obligation. The effort should continue unabated.
ADDITIONAL CURRICULUM CHANGES
UNDER CONSIDERATION
Committee Nominated to Study Possible Changes
In 1949 the Faculty of the School of Medicine completely revised the curriculum
for the 4th year. After 2 years of successful operation, Dr. H. Boyd Wylie, Dean, on
June 11, 1951, issued a memorandum to the Faculty nominating a Committee to
study in detail the current curriculum of the first 3 years to make recommendations
to the Faculty Board for the improvement of the curricula based on the findings from
a study of the curricula of other recognized medical schools.
The Committee, of which Dr. Theodore E. Woodward is Chairman, has begun the
arduous task of compiling information and recommendations. The details of the
progress and the conclusions of this most important task will be carried in future
editions of the Bulletin.
PROGRESS NOTE IV
>i
View of construction of new Psychiatric Building as of August 5, 1951
The American Medical Association Education Foundation needs your support.
MEDICAL SCHOOL SECTION iii
DEPARTMENT OF PEDIATRICS
Dr. James Minor, Resident in Pediatrics at the University Hospital from 1950-51
has entered the practice of Pediatrics in Norwalk, Connecticut. He is residing at 5
Norman Avenue in Norwalk.
Dr. Blackburn Joslin, Resident in Pediatrics at the University Hospital from 1949-
50 is currently stationed in Heidelberg, Germany as Chief of Pediatrics. His address
is 130 Station Hospital, A.P.O. 403, c/o Postmaster, New York, New York.
Dr. Edward Field, Assistant in Pediatrics, successfully passed the examination
given by the American Board of Pediatrics.
Dr. William Morgan, who helps in the instruction of residents on affiliation at the
Peninsula General Hospital, Salisbury, Maryland, also passed the examination given
by the American Board of Pediatrics.
The Seizure and Developmental Clinics were formally opened on June 22, 1951.
The opening was attended by various members of the State and City Health Depart-
ments, various social agencies, staff members and interested people in the field. The
Seizure Clinic is headed by Dr. Ruth Baldwin.
Recent publications from the Department of Pediatrics included:
An Evaluation of a Carbohydrate-Phosphoric Acid Solution in the Management of
Vomiting, J. Edmund Bradley, Leah Proutt, E. Roderick Shipley and Robert
H. Oster, Journal of Pediatrics, 38: No. 1, 41-44, Jan. 1951.
Sickle Cell Anemia, Frederick Heldrich, Journal of Pediatrics, 39: No. 1, July, 1951.
Treatment of Hemophilus Influenzae Meningitis with Chloramphenicol and Other
Antibiotics, Fred R. McCrumb Jr., Howard E. Hall, Jerome Imburg, Ann Mere-
dith, Master Sergeant Robert Helmhold, Juan Basora y Defillo, Theodore E. Wood-
ward, Journal of the American Medical Association, 145: 469-74, February, 1951.
Hemophilus Influenzae Pyarthrosis and Meningitis Treated with Aureomycin, Black-
burn S. Joslin and Ann Howard, Journal of Pediatrics, 38: No. 3, p. 375-79, March,
1951.
Dermatomyositis with Nephritis in a Negro Girl, J. Edmund Bradley, Miles E.
Drake and H. Patterson Mack, A. M. A. American Journal of Diseases of Children,
81: 403-407, March, 1951.
The Relation Between pH Changes and Rabbit Gut Motility in Vitro, Leah Proutt,
E. Roderick Shipley, Robert H. Oster, J. Edmund Bradley, Bulletin of the School
of Medicine, Univ. of Md., 36: No. 2, April, 1951.
Early Histologic Changes Following Obstruction of Pancreatic Ducts in Dogs:
Correlation with Serum Amylase. G. E. Gibbs and A. C. Ivy, Proceedings of the
Society for Experimental Biology and Medicine, 77: 251-54, 1951.
Treatment of Juvenile Thyrotoxicosis with Propylthiouracil, Miles E. Drake, Ann
Howard, Frederick Heldrich, Blackburn S. Joslin and Jerome Imburg, A. M. A.
American Journal of Diseases of Children, 1951.
iv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
DEPARTMENT OF RADIOLOGY
DR. JOHN M. DENNIS APPOINTED INSTRUCTOR IN RADIOLOGY
Dr. John M. Dennis has recently been appointed to the Faculty of the School of
Medicine as instructor in radiology and assistant roentgenologist in the University
Hospital.
Dr. Dennis is a graduate of the University of Maryland in the class of 1945 and
has spent 9 months as an intern in the University Hospital. He then served 2 years in
the U. S. Army as a roentgenologist and 2 years in the Department of Roentgenology
of the University Hospital as a resident. He has recently returned after an additional
year of study in his chosen field under Dr. Eugene E. Pendergrass at the University
of Pennsylvania Hospital. In June of 1951, Dr. Dennis was certified by the American
Board of Radiology.
MEDICAL LIBRARY NOTES
The following donors presented books and periodicals to the Medical Library
between May 1 and August 1, 1951:
Dr. Frank J. Figge Dr. Lyndon A. Peer
Dr. H. K. Fleck Dr. Maurice C. Pincoffs
Dr. Frank W. Hachtel Mrs. L. I. Whiteford
Mr. W. T. Meyers Dr. H. Boyd Wylie
Miss Elizabeth L. Clark and her sisters presented the library with a gift of great
interest in connection with the history of the School of Medicine. The gift consists of
a photograph of Dr. Corbin Amos, one of the earliest graduates of the School of
Medicine, and his certificate of membership in the Medical Society of Baltimore,
dated 1812. Both the picture and the certificate have been hung on the east wall of the
Medical Library.
TWO IMPORTANT POSTS TO BE FILLED BY DR. LOUIS H. DOUGLASS
Dr. Louis H. Douglass, Professor of Obstetrics, was recently elected Chairman of the
Sect'on on Obstetrics and Gynecology of the American Medical Association and also
Vice-President of a newly formed American Academy of Obstetrics and Gynecology.
DEPARTMENT OF NEUROSURGERY
Dr. Richard G. Coblentz of the Department of Neurosurgery recently spoke at a
meeting of the Delaware Medical Society on the subject of "Head Injuries".
MURRAY-BAUMGARTNER
-SURGICAL INSTRUMENT COMPANY INC.(*H
Equipment and Supplies for:
Doctors
Hospitals
Laboratories
Industrial Clinics
5 West Chase Street Baltimore-1 , Md.
NEW FACULTY APPOINTMENTS AND PROMOTIONS
ANNOUNCED FOR THE ACADEMIC YEAR
SEPTEMBER 20, 1951 TO JUNE 7, 1952
VISITING PROFESSORSHIPS:
Lloyd D. Felton, A.B., D.Sc, M.D., Visiting Research Professor of Bacteri-
ology.
(Effective June 1, 1951)
John R. Reid, Ph.D., Visiting Professor of Psychiatry.
(Effective September 1, 1950)
PROFESSORSHIPS BY PROMOTION ARE AS FOLLOWS:
C. Jelleff Carr, Ph.D., From Associate Professor of Pharmacology to Professor
of Pharmacology.
I. Ridgeway Trimble, M.D., From Associate Professor of Surgery to Professor
of Clinical Surgery.
ASSOCIATE PROFESSORSHIPS BY PROMOTION:
Frederick P. Ferguson, Ph.D., From Assistant Professor of Physiology to Asso-
ciate Professor of Physiology.
D. Frank Kaltreider, A.B., M.D., From Assistant Professor of Obstetrics to
Associate Professor of Obstetrics.
Ida M. Robinson, A.B. B.S.L.S., From Librarian to Associate Professor of
Library Science.
J. McCullough Turner, Ph.D., From Assistant Professor of Physiology to Asso-
ciate Professor of Physiology.
ASSISTANT PROFESSORSHIPS BY PROMOTION ARE AS FOLLOWS:
Karl F. Mech, B.S., M.D., From Associate in Anatomy to Assistant Professor
of Anatomy.
Robert A. Reiter, M.D., From Associate in Medicine to Assistant Professor of
Medicine.
Arthur G. Siwinski, A.B., M.D., From Associate in Surgery to Assistant Pro-
fessor of Surgery.
ASSOCIATES BY PROMOTION:
Robert Z. Berry, A.B., M.D., From Instructor in Otolaryngology to Associate
in Otolaryngology.
Louis V. Blum M.D., From Assistant Pediatrician to Associate in Medicine.
William R. Bundick, M.D., From Instructor in Dermatology to Associate in
Dermatology.
Jonas Cohen, M.D., From Instructor in Medicine to Associate in Medicine.
John S. Haines, M.D., From Instructor in Urology to Associate in Urology.
Walter Karfgin, M.D., From Instructor in Medicine to Associate in Medicine.
vi BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID.
Louis B. Kroll, A.B., M.D., From Instructor in Medicine to Associate in Medi-
cine.
H. Patterson Mack, M.D., From Instructor in Anatomy to Associate in Anat-
omy.
Patrick C. Phelan, Jr., A.B., M.D., From Instructor in Anatomy and Surgery
to Associate in Anatomy.
Raymond K. Thompson, B.S., M.D., From Instructor in Neuro-Surgery to
Associate in Neuro-Surgery.
Edward H. Stewart, Jr., M.D., From Instructor in Surgery to Associate in
Surgery.
Arthur Ward, M.D., From Assistant in Otolaryngology to Associate in Otolaryn-
gology.
Daniel Wilfson, Jr., A B., M.D., From Instructor in Medicine to Associate in
Medicine.
INSTRUCTORS BY PROMOTION ARE AWARDED AS FOLLOWS:
Joseph G. Bird, A.B., M.D., From Assistant in Pharmacology and Medicine to
Instructor in Medicine.
John W. Chambers, M.D., From Assistant in Neuro-Surgery to Instructor in
Neuro-Surgery.
Maurice Feldman, Jr., A.B., M.D., From Assistant in Medicine to Instructor
in Medicine.
Maurice Fine, M.D., From Assistant in Medicine to Instructor in Medicine.
Joseph E. Furnari, M.D., From Assistant in Medicine to Instructor in Medicine.
Perry O. Futterman, A.B., M.D., From Assistant in Medicine to Instructor in
Medicine.
Irvin B. Kemick, B.S., Phar. G., M.D., From Assistant in Medicine to Instructor
in Medicine.
James J. Nolan, B.S., M.D., From Assistant in Medicine to Instructor in Medi-
cine.
Frank J. Otenasek, M.D., From Assistant in Neuro-Surgery to Instructor in
Neuro-Surgery.
Charles E. Shaw, M.D., From Assistant in Medicine to Instructor in Medicine.
Jerome Sherman, M.D., From Assistant in Medicine to Instructor in Medicine.
Elizabeth D. Sherrill, M.D., From Assistant in Medicine to Instructor in Medi-
cine.
Stuart D. Sunday, M.D., From Assistant in Medicine to Instructor in Medicine.
Stephen J. VanLill, III, A.B., M.D., From Assistant in Medicine to Instructor
in Medicine.
(To Be Concluded)
See President's Letter to Alumni for important Educational News.
MEDICAL SCHOOL SECTION
CANCER SEMINAR PROGRAM— 1951-1952
(The third Wednesday in every month from 4 until 5 p.m.)
Topic
"Carcinoma of the Bladder"
Dale Speaker
October 17, 1951 Dr. Hugh J. Jewett
Johns Hopkins Hospital
Baltimore, Maryland
November 14, 1951 Dr. Joseph H. Burchenal
The Sloan-Kettering Institute for
Cancer Research
New York, New York
February 20, 1952 Dr. W. U. Gardner (tentative)
Yale University
School of Medicine
New Haven, Connecticut
March 19, 1952 Dr. Alfred Blalock
Johns Hopkins Hospital
Baltimore, Maryland
All lectures will be given in the Gordon Wilson Hall, University Hospital unless posted.
ACADEMIC CALENDAR
The Bulletin publishes herewith the Academic Calendar for the current year. This is an important
item for reference purposes.
"The Treatment of the Malignant
Lymphomas"
Experimental Ovarian and
Lymphoid Tumorigenesis"
"Mediastinal Tumors"
1951
November 20 Tuesday
November 25 Monday
December 21 Friday
Academic Year — November 20, 1951 to June 7, 1952
Instruction suspended at 5:00 P.M.
Thanksgiving Holiday
Instruction resumed, 8:30 A.M.
Instruction suspended at 5:00 P.M.
Christmas Holiday
1952
January 3 Thursday
January 21 Monday
January 26 Saturday
Instruction resumed, 8:30 A.M.
Midyear examinations (Senior classes continue throughout this week)
First semester completed, 2:00 P.M.
January
28
Monday
February
21
Thursday
February
22
Friday
February
23
Saturday
April
10
Thursday
April
15
Tuesday
April
22
Tuesday
April
23
Wednesday
May
19
Monday
May
24
Saturday
May
26
Monday
May
30
Friday
May
31
Saturday
June
7
Saturday
Second Semester — January 28, 1952 to June 7, 1952
Instruction begins at 8:30 A.M.
Instruction suspended at 5:00 P.M.
Holiday — Washington's Birthday
Instruction resumed 8:30 A.M.
Instruction suspended at 5:00 P.M.
Easter Holiday
Instruction resumed 8:30 A.M.
Juniors and Seniors excused to attend annual meetings of the Medical
and Chirurgical Faculty
Junior examinations begin
Senior classes cease at 5:00 P.M.
Junior examinations continue
Sophomore and Freshman examinations begin
Holiday — Memorial Day
Announcement of graduates
Commencement
Second semester completed at 12:30 P.M.
POST GRADUATE COMMITTEE SECTION
POST GRADUATE COMMITTEE, SCHOOL OF MEDICINE
Howard M. Bubert, M.D., Chairman and Director
Elizabeth Carroll,
Executive Secretary
Post Graduate Office : Room 600
29 South Greene Street
Baltimore 1, Maryland
Some years ago, The Faculty Board, assigned to the Post Graduate Committee
the task of studying and endeavoring to arrive at a solution to the problem of staffing
hospitals throughout the state of Maryland. It is the collective opinion of the Post
Graduate Committee that this problem represents one of the most pressing needs of
the medical facilities of the community, a need that must be satisfied at the earliest
practicable date. A subcommittee consisting of Doctors J. Edmund Bradley, Chair-
man; J. Morris Reese, Weatherbee Fort and D. C. Smith was appointed by the
Chairman and Director of the Post Graduate Committee at the direction of the full
Committee, and for many months this problem was considered and a plan made.
This plan was incorporated in a report to the Post Graduate Committee and ap-
proved in principle. The Post Graduate Committee realizes that this is simply a point
of departure for further study and consideration and that a great deal of time and
effort must be expended before an acceptable solution is found. It was the Commit-
tee's opinion that publication of this plan would serve to arouse interest in the
problem, and possibly, worthwhile discussion.
Report of the Subcommittee on Hospital Survey
Questionnaires were sent to 14 of the 16 hospitals in Baltimore City. The University
and Johns Hopkins hospitals were excluded as the data on these were considered to
be readily available. All questionnaires were returned. The surveyed hospitals had a
total bed capacity of 5,095 with a daily census of 3,770 patients. There were 165,167
patients treated in their out-patient departments and 20,225 births occurred in the
same hospitals. There were 202 residents on duty and approval for 156 interns had
been given these hospitals, but only 97 positions have been filled. The diagnostic
facilities provided by the city hospitals were considered to be generally adequate;
however, only 9 of the surveyed hospitals have facilities for therapeutic roentgenology.
The teaching program for the residents and interns was considered to be good in ap-
proximately one-half of the surveyed hospitals. It is to be noted, however, that the
teaching programs made liberal use of the facilities of the University of Maryland and
Johns Hopkins Hospitals and their respective medical schools.
Questionnaires were also sent to 18 of the rural hospitals of Maryland, 14 of which
have been returned to date. This represents a total of 1255 beds with a total daily cen-
POST GRADUATE COMMITTEE SECTION ix
sus of 751 patients. There were 6,320 births and a total of 37,079 out-patients treated.
There were 6 rotating residents on duty in the rural hospitals, 4 of the 6 being rotating
residents from the University of Maryland and University of Pennsylvania. Approval
had been given, however, for a total of 10 interns, but there were no interns on duty
in any of the rural hospitals. The diagnostic facilities in the rural hospitals showed a
wide variation. Only 9 were equipped to do biochemical studies and only 6 to do bac-
teriologic studies. Only 2 of the rural hospitals had a library housed in a separate
room, and there was a combined total of 68 journals subscribed to as compared to 506
in the city hospitals. One hospital subscribed to none and 1 to only 1 journal. Only 5
of the rural hospitals had a medical record library and only 9 had a medical record
librarian. Two of the rural hospitals had facilities for therapeutic roentgenology and
3 did not even have a radiologist serving in the hospital. Teaching programs, with the
exception of 2 of the reporting rural hospitals, were practically nonexistent.
From this survey, it is evident that medicai training at the graduate or hospital
level lacks uniformity. It is also suggested that the patient care rendered by the vari-
ous hospitals in our city and state show a wide variation, a variation that clearly does
not lend itself to the provision of equally good medical care for all.
The medical schools of this country prepare men and women for the practice of
medicine through reasonably standard curricula of content and duration. However,
graduate training at the hospital level has been left almost entirely to the individual
hospitals. This policy has resulted in unevenness in the training of graduates, despite
strenuous efforts which have been made throughout the last 50 years by various agen-
cies to improve the type of medical training received in these hospitals. It seems to
the Committee that the medical school is the logical agency to plan and to direct the
program for a uniform type of graduate training designed to prepare a man, upon
completion of such training, for the general practice of medicine. A program under
aegis of the medical schools should approach the problem with the understanding that
all hospitals are potential teaching units and with the realization that development of
this potential will result in approved training for physicians which in turn will result
in improved medical care for the community. This subcommittee, therefore, recom-
mends that all hospitals be considered as graduate teaching units and that steps be
undertaken by the Director of the Post Graduate Committee of the University of
Maryland School of Medicine to bring together the deans of the medical schools of
the state of Maryland to utilize this teaching potential as a measure to prepare phy-
sicians for the practice of medicine uniformly, thereby enhancing the postgraduate
opportunities for practicing physicians and resulting in improved medical care for the
people of Maryland.
In the State of Maryland, a program under the direction of the two medical schools
could be set up utilizing all the hospitals of the state and city, through provision of an
internship of two years' duration. The reason for recommending a two years' intern-
ship is that, in the opinion of this Committee, an internship of this duration is neces-
sary to prepare a physician adequately for the practice of medicine. Further, it means
that there would then be available interns for all of the hospitals throughout the city
and state. The content of the training program should closely follow the recommenda-
tions of various bodies that have concerned themselves with the training required to
x BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
prepare a physician for the practice of medicine. It is suggested that the first year of
the training program of the intern be spent in the teaching hospitals. The term "teach-
ing hospitals" is used here to include those hospitals which would be designated as
such by the medical school and is not restricted to the hospitals at present associated
with the medical schools. This does not infer that the man would spend his first year
completely and entirely in one hospital, but that he would rotate to various hospitals
in the city and state to obtain training where it is best possible to give that training.
For example, pediatric training might be secured in one of four institutions in the
city that provide adequate facilities for pediatric training. The second year of the
program would be spent in rotation as resident in general medicine in some of
our smaller hospitals. Plans for affiliating resident training, that is, training for
physicians at a more advanced level, is not included in this recommendation.
The value of this type of training to the individual, to the hospital, and to the
patient need not be elaborated upon. It becomes immediately obvious that embarking
upon such a program would of necessity mean that all of the hospitals must be raised
to a standard that, in the opinion of the medical schools, is conducive to good medical
training. These standards should be arrived at through consultation of the deans of
the medical schools and representatives of the hospitals as well as concerned educa-
tors. It is to be unequivocally recognized that training of this type is designed to pre-
pare men and women for the practice of medicine and does not mean that they are to
be exploited by the various hospitals for the performance of duties that in the past,
and even the present, are considered to be menial duties that could be performed by
trained technicians and other trained personnel.
The subcommittee thereby recommends the inauguration of a two-year rotating
intern program, covering the main branches of medicine, surgery, obstetrics, gyne-
cology, and pediatrics with standards of teaching acceptable to the deans of the
medical schools of the State of Maryland and their consultants.
The financing of a program of this type, in the opinion of the Committee, should
be done through appropriations from the Maryland State Legislature. It would be
unfair to place the financial responsibility for such a program upon the individual
hospitals, for by doing so it would be their natural tendency to pass on the cost of this
educational program to the patient, whereas, it is the feeling of the Committee that a
program of this type is of value to all members of the state and should not be a penalty
for illness or for those who utilize the facilities of a local hospital. It has been esti-
mated roughly that a sum of 8600,000 would be adequate to finance the program
through providing the following services, estimating that two residents could be
assisgned to 22 rural hospitals and each received a stipend of $150 a month plus 8350
yearly maintenance for the individual would total a sum of about 895,000. Super-
visory services for these hospitals at $100 per month per service and estimating that
two services need to be covered, would amount to 852,800. The total of these two
figures for rural hospital coverage would amount to 8147,800. It is estimated that in
the city hospitals a total of 430 residents should receive 850 monthly each which
would total $258,000, while maintenance for these men at the same basis of 8350
yearly would total 8150,500. Servicing of a supervisory nature, estimating that there
would be four major services to be supervised in 16 hospitals at a cost of 850 per serv-
POST GRADUATE COMMITTEE SECTION xi
ice per month, would total $38,400. Thereby the total amount represented for city
coverage would then be 84-46,900. The financing of a program through this means
would relieve the hospital of the responsibility of supplying salaries and maintenance
for house officers engaging in training and should mean that additional money would
be available in the hospitals for improvement of educational facilities.
This subcommittee thereby recommends that the financing of training medical
graduates through a decentralized program be submitted to the Maryland State
Legislature.
A point of interest that needs to be considered in connection with the educational
program as above outlined is the present policy of the Maryland State Board of Med-
ical Examiners. At present, it is possible for a physician to practice medicine in the
State of Maryland upon completion of a State Board examination without any
hospital training. This, in the opinion of the subcommittee, would or might seriously
impair the validity of any wide educational program. It seems that it would be
necessary and desirable that the Maryland State Board of Examiners change their
license requirements to make compulsory at least one year of hospital training before
a physician can practice medicine in the state of Maryland.
This subcommittee therefore recommends that the Maryland State Board of Med-
ical' Examiners be made aware of the thinking of this Committee and that steps be
taken to make compulsory at least one year of hospital training before a physician
can practice medicine in the State of Maryland.
ALUMNI ASSOCIATION SECTION
OFFICERS
Daniel J. Pessagno, M.D., President
Vice-Presidents
James Marsh, M.D. William E. Lennon, M.D. Harry L. Rogers, M.D.
Simon Brager, M.D., Secretary Edwin H. Stewart, Jr., M.D., Assistant Secretary
Minette E. Scott, Executive Secretary Thurston R. Adams, M.D., Treasurer
Board of Directors
Louis A. M. Krause, M.D.
Chairman
Daniel J. Pessagno, M.D.
Thurston R. Adams, M.D.
Simon Brager, M.D.
Edwin H. Stewart, Jr., M.D.
Wetherbee Fort, M.D.
Albert E. Goldstein, M.D.
Thomas K. Galvin, M.D.
William H. Triplett, M.D.
George H. Yeager, M.D.
Louis H. Douglass, M.D.
Hospital Council
Alfred T. Gundry, M.D.
George F Sargent, M.D.
Nominating Committee
Robert F. Healy, M.D.,
Chairman
Ernest I. Cornprooks, M.D.
Frank K. Morris, M.D.
David Tenner, M.D.
Arthur Siwinski, M.D.
Alumni Council
Library Committee
Milton S. Sacks, M.D.
Representatives to General Alumni
Board
John A. Wagner, M.D.
Thurston R. Adams, M.D.
William H. Triplett, M.D.
Representatives, Editorial Board,
Bulletin
Harry C. Hull, M.D.
Albert E. Goldstein, M.D.
Daniel J. Pessagno, M.D.
(ex- officio)
Lewis P. Gundry, M.D.
The names listed above are officers for the term beginning July 1, 1951 and ending June 30, 1952.
PRESIDENT'S LETTER
Enrollments in the 72 approved medical schools of the United States have expanded
greatly. At the end of 1950, physicians in the continental United States totaled
202,040, the largest number on record. The combined freshman class for 1950-51
reached an all time high of more than 7,000. Never before have there been so many
students preparing to enter the field of medicine. It has been estimated that in 1960
there will be an increase of 30 per cent more physicians graduating than in 1950.
Failure to maintain our present high standards in medical education would be dis-
astrous to the future of medical care.
The medical schools are facing major financial problems today with higher opera-
tional costs, inflation and lower income from endowments. Individual large bene-
factions are few. We must have additional financial support if we are to continue to
serve the American people with a greater supply of well-trained physicians. The
financing of medical education should be a major concern to all.
This needed support must not come from the federal government for that would
only mean a relaxation of our efforts in our constant fight against the socialization of
medicine. It is the belief of the American Medical Association that support should
come from private sources which are far from exhausted. Once the need is brought to
the attention of the medical profession and laymen, especially those who recognize the
value of the medical schools' contribution to society, we can continue to secure the
needed funds from voluntary sources. However, the primary responsibility in securing
these funds falls on each one of us.
ALUMNI ASSOCIATION SECTION
The National Fund for Medical Education was established on May 16, 1951. It is
sponsored by outstanding leaders from the fields of public affairs, business, industry,
agriculture, labor, higher education, the American Medical Association and the
Association of American Medical Colleges. Former president Herbert Hoover is the
honorary chairman of its board of 66 trustees. The purpose of this organization of lay-
men is to raise funds by private subscrip-
tion to forestall any attempt of the federal
government to assume support of medical
schools.
The American Medical Education Foun-
dation has been chartered as a not-for-profit
corporation under the laws of the State of
Illinois to provide an instrument whereby
physicians and state and county medical
societies can make their contributions to the
National Fund. One hundred per cent is
contributed with nothing deducted for ex-
penses.
In addition to making their own contribu-
tions physicians can render invaluable serv-
ice by encouraging officers of companies and
corporations of their acquaintance to con-
tribute to the fund. If the medical profes-
sion will lead the way, others will follow.
Individuals and corporation officials who
object to government subsidy of medical education surely share the responsibility
of producing other income.
The American Medical Association estimates that if every member of the medical
profession were to make an average yearly contribution of $100, nearly $18,000,000
in new income would be provided.
I am urging each member of the alumni to send his contribution to the American
Medical Education Foundation, 535 N. Dearborn St., Chicago-10, Illinois. Provision
has been made in arrangements between the Foundation and the Fund for handling
any special requests so that contributions may be allocated to any particular school
designated by the contributor.
The funds collected will be distributed to all approved medical schools for un-
restricted use, each institution being entirely free to determine how best to utilize
its share in medical training.
Daniel J. Pessagno, M.D., President
ALUMNI DAY, 1951
Registration at the annual Alumni Day activities again represented an unusual
degree of enthusiasm as noted among the many out-of-town Alumni returning for this
occasion. Approximately 200 were present at the clinical session and annual luncheon
with over 400 attending the banquet given in honor of the class of 1951.
Dr. D. J. Pessagno
Photo : Fabian Bachrach
xiv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
The Scientific session included two clinical pathologic conferences and a clinical
demonstration of "The Surgical Relief of Hemiballismus" by Drs. George Smith and
Richard Coblentz. Following the customary luncheon, the annual business meeting
of the Medical Alumni Association was held. After the usual reports of the Officers
and Committees, Dr. William H. Triplett read the Necrology. The Treasurer reported
a net balance, after expenditures, of $6,375.70.
Dr. Christopher C. Shaw then spoke of a recent trip to Japan and suggested that
the Alumni Association sponsor an exchange fellowship.
kpt ^Bh
[ -_■
M
^K %\ 1^1 '
H^^^~p
wmr WmNR
*
^&
B9 BHHHH^HH!
(Hi
(H*
Dr. Louis A. M. Krause presents the Alumni Honor Award to Dr. George E. Bennett
Dr. Joseph J. Bowen suggested that some fitting memorial be erected to the Alumni
who lost their lives in World War II. The subject of these two items will be discussed
at the next meeting of the Board of Directors and will be published in a forthcoming
issue of the Bulletin.
Dr. George E. Bennett, Professor Emeritus of Orthopedics at the Johns Hopkins
School of Medicine and a member of the class of 1909, was then introduced as the
principal speaker. Dr. Bennett spoke on "Reminiscences of the Class and Faculty of
1909." Following his address, Dr. Bennett was presented with the annual Alumni
Honor Award, a scroll and a gold key, by Dr. Louis A. M. Krause, President of the
Alumni Association. As the ceremonies closed, the President read a most interesting
telegram addressed to Dr. Bennett from Dr. John S. Norman of King's Mountain,
ALU MX I ASSOCIATION SECTION xv
North Carolina, a classmate. "To him who triumphs may the laurel victory be your
crown and the coming years you shall climb upward to greater heights on the ladder
of fame viewed by men who honor your efforts and hope for you an Eden of peace and
joy forever, God willing. My love to all the boys."
ALUMNUS CONTRIBUTES FIRST CHECK TO AMERICAN MEDICAL
EDUCATION FOUNDATION
Dr. Robert H. Dreher, class of 1934, who practices in Wind Gap, Pennsylvania,
was the first American physician to contribute to the American Medical Education
Foundation. As an alumnus of the School of
Medicine, his action typifies the interest,
leadership and loyalty for which due recog-
nition and acknowledgement should cer-
tainly follow.
Other alumni of the . School of Medicine
have already contributed to the Foundation
for the year 1951. Acknowledgement of
these contributions will be published as soon
as the completed list is available.
If you have not as yet contributed, your
check should be mailed without delay to the
American Medical Education Foundation,
535 North Dearborn Street, Chicago 10.
You may request that your contribution be
turned over in its entirety to the School of
Medicine. Remember, your entire dollar
goes for medical education unfettered. The Dr- R- H. Dreher
American Medical Association and the endowments of the National Fund for Medi-
cal Education, the dispensing agency, assume the administrative costs.
Contributions are deductible for income tax purposes.
The University of Maryland is first — keep it there. See School News.
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
REGISTRANTS ON ALUMNI DAY
1886
R. Sumter Griffith
1895
Thomas W. Keown
1897
Lucius N. Glenn
J. A. Baer
Benjamin H. Dorsey
Norman S. Dudley
Charles T. Fisher
Campbell Flautt
Frank A. Glantz
1904
Charles Bagley, Jr.
Louis H. Douglass
William T. Gocke
J. J. Greengrass
John F. Hogan
Frank L. Jennings
F. H. Hutchinson
Robert E. S. Kelly
Albert E. Goldstein
Philip J. Bean
James W. Katzenberger
Louise A. M. Kraus
Louis C. Dobihal
F. A. Holden
Nicholas G. Wilson
1898
Page Edmunds
1901
James McClung
John B. McMurray
William T. Messmore
R. Gibson Perry, Sr.
William R. Rogers
Arthur Vanderbeek
Virgil G. Williams
1906
Arnold D. Tuttle
1909
George E. Bennett
Harry M. Robinson, Sr.
1911
Joseph B. Kilbourn
B. L. Symkowski
J. E. Springer
William H. Triplett
Ralph J. Vreeland
Louis V. Williams
Caldwell Woodruff
1912
H. Boyd Wylie
1913
Charles Reid Edwards
1914
John F. Lutz
1917
Lawrence H. Wheeler
1920
George C. Medairy
William J. B. Orr
J. Morris Reese
ALUMNI ASSOCIATION SECTION
1921
Bruce Barnes
C. F. Fisher
Daniel Keegan
Francis A. Reynolds
E. Martinez-Rivera
J. S. Schilling
Felix Shubert
H. E. Wangler
George A. Knipp
M. Paul Byerly
Harry Anker
John Askin
Margaret Ballard
Irvin Bronsten
Elias Diamond
Abel Gordon
David Helfond
Louis Lavy
Joseph Levin
H. Edmund Levin
Frank Lusby
Nelson Carey
Byruth Lenson-Lambros
1922
Joseph Stovin
1923
Karl J. Myers
1925
Leo T. Brown
1926
Emanuel Manginelli
Albert Moriconi
William C.- Polsue
Albert Rosenberg
Abraham Rothberg
David Sashin
Jacob Schmuckler
Elizabeth Sherman
E. V. Teagarden
Maurice Teitelbaum
Samuel Weinstein
Louis Weseley
1927
A. H. Finkelstein
Frank K. Morris
Herbert E. Reifschneider
1929
George H. Yeager
1930
Kenneth L. Benfer
M. Ray Hannum
K. M. Hornbrook
Page Jett
Walter J. Keefe
H. V. Langeluttig
D. G. Mankovich
John C. Dumler
Harrv C. Hull
Emil Hildenbrand
1931
Waldo Moyers
Christopher C. Shaw
Arthur G. Siwinski
Michael Skovron
Alexander Slavcoff
Robert B. Taylor
1932
Samuel E. Proctor
John E. Savage
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Thurston R. Adams
1934
Milton S. Sacks
Ernest I. Cornbrooks, Jr.
William Greifinger
C. Henry Jones
Walter E. Karfgin
Everett S. Diggs
D. Frank Kaltreider
Ephraim T. Lisansky
Louis C. Gareis
Robert C. Sheppard
Raymond M. Cunningham
Edmund G. Beacham
J. A. Arnett
Charles P. Barnett
Joseph J. Bowen
J. Culpepper Brooks
William L. Bundick
Pierson M. Checket
Van B. Bennett
Joseph G. Bird
Robert M. N. Crosby
David B. Gray
John S. Haught
J. Carlton Godlove
Henry J. Holljes
1935
Howard B. Mays
Karl F. Mech
1936
Eugene R. McNich
M. J. Nicholson
S. D. Pentecoste
Gibson J. Wells
1937
Joseph E. Muse, Jr.
Samuel T. Revell, Jr.
C. Parke Scarborough
J. King B. E. Seegar
1938
John A. Wagner
Theodore E. Woodward
1939
Dexter Reimann
1940
W. H. Townshend, Jr.
1941
Felix R. Morris
Frank S. Renna
Benedict Skitarelic
H. R. Spinnler
Edwin F. Wilson
Kazuo Yanagisawa
1942
Joseph Furnari
Theodore Kardash
E. Roderick Shipley
1943
DeVoe K. Meade
Alfred T. Nelson
Edwin H. Stewart, Jr.
Stephen Van Lill
1944
Charles E. Shaw, Jr.
F. X. Paul Tinker
ALUMNI ASSOCIATION SECTION
Thomas G. Barnes
Sarah Cook
Jerome E. Cohn
Paul E. Frye
John Gamble, Jr.
Harry W. Gray
Charles W. Hawkins
Arlie R. Maneberger, Jr.
John R. Hankins
Frederick J. Heldrich, Jr.
Charles T. Henderson
Charles Bagley, III
Mary V. Barstow
1945
James R. McNich
S. Malone Parham
John J. Tansey
1946
Jerome D. Nataro
Pomeroy Nichols. Jr.
E. Milton Smith
Edward P. Smith, Jr.
Joseph B. Workman
1947
Wallace H. Mitchell
1948
H. Patterson Mack
William S. Womack
1949
John F. Strahan
1950
Francis J. Borges
S. W. Henson, Jr.
Plates of the School of Medicine, University of Maryland, the New Hospital, and the
Old Hospital are available. These white plates are 10 inches in diameter with black print.
The price is $2.50 each, plus 25 cents insurance and postage. Send order, stating the plates
desired, with check to Mrs. Bessie M. Arnurius, Box 123, University Hospital, Baltimore,
Maryland. Make check payable to Nurses Alumnae Association of the University op
Maryland.
ALUMNI DAY HIGHLIGHTS
Dr. William Rogers and Dr. Arnold D. Tuttle chat at luncheon. (Top)
(Dr. Tuttle died Oct. 6, 1951— Ed.)
Dr. A. H. Finkelstein and Dr. Abel Gordon talk it over. (Center)
Dr. Earl Springer of Akron, Ohio. (Bottom L.)
Dr. Thomas W. Keown, class of 1895, B.M.C. (Bottom R.)
ALUMNI ASSOCIATION SECTION
ALUMNI DAY HIGHLIGHTS
^- " ^0^.,,
*"
Dr. Louis A. M. Krause addresses the annual meeting. (Top)
A threesome. Drs. William J. B. Orr, Lucius Glenn, and Page Edmunds. (Center)
Registration desk.
1 to r — Dr. H. Edmund Levin, and Dr. Page Edmunds. (Bottom)
BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD.
Class of 1921 (Top)
L to r— C. F. Fisher, F. S. Shubert, F. A. Reynolds, Louis Lass, H. E. Wangler, J. M. Schilling.
Class of 1946 (Center)
Front row, 1 to r— John R. Gamble, Harry Gray, Jerome Xataro, E. Milton Smith, Jr. Back row,
1 to r — Joseph Workman, Edward P. Smith, Jr., Paul Frey.
Class oj 1941 (Bottom)
Front row, 1 to r— Jerome C. Arnett, J. Culpepper Brooks, Jr., William R. Bundick, Felix R.
Morris. Back row, 1 to r— Joseph J. Bowen, Francis S. Renna, Pierson M. Checket, Benedict' Skita-
relic.
11»P
*2 d
K Oft,
£ SZw
•a a
P.S a J
— — ' rt — .
O f2 Oh O
co Q O co
NCOa Oh N«
s-
bo a>
(3 60
3 JS
bo"° .S
.2j.2
TJ ^ T3
_ t3 bo
•aCQ-2
iffl
c bo
32 c
00 "3 .2
-PQ .2
b > >»
rt.2 Q 2
" - £-2
8«->
u, d k.
o J m
0< g
*-" N fO ^
BULLETIN
OF THE
SCHOOL of MEDICINE
UNIVERSITY OF MARYLAND
September, 195 1
Announcements for
The One Hundred Forty-Sixth Academic Session
1951-1952
Catalogue of
The One Hundred Forty-Fifth Academic Session
1950-1951
CALENDAR
1951
1952
1953
JULY
JANUARY
JULY
JANUARY
s
M
T
W
T
F
S
S
M
T
W
T
F
S
S
M
T
w
T
F
S
S
M
T
VV
T
F
S
1
2
3
4
5
6
7
1
2
3
4
5
1
2
3
4
5
1
2
3
8
9
10
11
12
13
14
6
7
8
9
10
11
12
6
7
8
9
10
11
12
4
5
6
7
8
9
10
15
!o
17
18
19
20
21
13
14
15
16
17
18
19
13
14
15
16
17
IS
19
11
12
15
14
15
16
17
22
23
24
25
26
27
28
20
21
22
23
24
25
26
20
21
22
23
24
25
20
IS
19
20
21
22
23
24
29
30
31
27
2S
29
30
31
27
28
29
30
31
25
20
27
28
29
30
31
AUGUST
FEBRUARY
AUGUST
FEBRUARY
S
M
T
VV
T
F
S
S
M
T
w
T
F
S
S
M
T
VV
T
F
S
S
M
T
VV
T| F
S
1
2
3
4
1
2
1
2
1
2
5
4
5
6
7
5
6
7
8
9
10
11
3
4
5
6
7
8
9
3
4
5
6
7
8
9
8
9
10
11
12
15
14
12
13
14
15
16
17
18
10
11
12
13
14
15
16
10
11
12
13
14
15
10
15
10
17
IS
19
20
21
19
20
21
22
23
24
25
17
IS
19
20
21
22
23
17
18
19
20
21
22
23
22
23
24
25
26
27
28
26
11
28
29
30
31
24
25
26
27
28
29
24
31
25
26
27
2S
29
30
SEPTEMBER
MARCH
SEPTEMBER
MARCH
S
M
T
W
T
F
S
S
M
T
W
T
F
S
S
M
T
VV
T
F
S
S
M
T
VV
T
F
S
1
8
2
3
4
5
6
1
1
8
"i
1
8
2
9
3
10
4
11
5
12
0
13
1
8
2
9
3
10
4
11
5
12
6
15
7
14
2
3
4
5
()
7
9
10
11
12
13
14
15
9
10
11
12
13
14
15
14
15
16
17
IS
19
20
15
10
17
18
19
20
21
16
17
IS
19
20
21
22
16
17
IS
19
20
21
22
21
22
23
24
25
20
27
22
23
24
25
26
27
28
23
24
25
26
27
28
29
23
24
25
26
27
28
29
28
29
30
29
30
51
30
30
31
OCTOBER
APRIL
OCTOBER
APRIL
S
M
T
W
T
F
S
S
M
T
VV
T
F
S
S
M
T
VV
T
F
S
S
M
T
VV
T
F
S
1
2
3
4
5
6
1
2
3
4
5
1
2
3
4
1
2
3
4
7
8
9
10
11
12
13
6
7
8
9
10
11
12
5
6
7
8
9
10
11
5
6
7
8
9
10
11
14
15
16
17
IS
19
20
13
14
15
16
17
18
19
12
13
14
15
16
17
18
12
13
14
15
16
17
18
21
22
23
24
25
20
27
20
21
22
23
24
25
26
19
20
21
22
23
24
25
19
20
21
22
23
24
25
28
29
30
31
27
28
29
30
26
27
28
29
30
31
26
27
28
29
30
NOVEMBER
MAY
NOVEMBER
MAY
S
M
T
VV
T
F
S
S
M
T
W
T
F
S
S
M
T
W
T
F
S
S
M
T
VV
T
F
S
1
8
2
9
3
10
4
5
6
7
1
8
2
9
3
10
2
3
4
5
0
"7
1
8
1
8
2
9
4
5
6
7
3
4
5
6
7
11
12
13
14
15
16
17
11
12
13
14
15
16
17
9
10
11
12
13
14
15
10
11
12
13
14
15
16
18
19
20
21
22
23
24
18
19
20
21
22
23
24
16
17
18
19
20
21
22
17
18
19
20
21
22
23
25
26
27
28
29
30
25
26
27
28
29
30
31
23
30
24
25
26
27
28
29
24
31
25
26
27
28
29
30
DECEMBER
JUNE
DECEMBER
JUNE
S
M
T
VV
T
F
S
S
M
T
VV
T
F
S
s
M
T
VV
T
F
S
S
M
T
VV
T
F
S
1
1
2
3
4
5
6
7
1
2
3
4
5
6
1
2
3
4
5
6
2
3
4
5
6
7
8
8
9
10
11
12
13
14
7
8
9
10
11
12
15
7
8
9
10
11
12
13
9
10
11
12
13
14
15
15
16
17
IS
19
20
21
14
15
10
17
18
19
20
14
15
16
17
18
19
20
16
17
18
19
20
21
22
22
23
24
25
26
27
28
21
22
23
24
25
20
27
21
22
23
24
25
26
27
23
24
25
26
27
28
29
29
30
28
29
50
31
28
29
50
30
31
CALENDAR
Academic Year — September 20, 1951 to June 7, 1952
1951
September
10,
11, 12
FIRST SEME
September
18
Tuesday
September
19
Wednesday
September
20
Thursday
November
20
Tuesday
November 26
Monday
December
21
Friday
1952
January
3
Thursday
January-
21
to
Monday
January
26
Saturday
January
28
Monday
February
21
Thursday
February
22
Friday
February
23
Saturday
April
10
Thursday
April
15
Tuesday
April
22
Tuesday
April
23
Wednesday
May
19
Monday
May
24
Saturday
May
26
Monday
May
30
Friday
May
31
Saturday
June
7
Saturday
Re-examinations for advancement
FIRST SEMESTER— September 20, 1951 to January 26, 1952
*Registration, payment of fees, freshmen & sophomores
*Registration, payment of fees, all other students
Instruction begins at 8:30 a.m.
Instruction suspended at 5:00 p.m.
Thanksgiving Holiday
Instruction resumed
Instruction suspended at 5:00 p.m.
Christmas Holiday
Instruction resumed
Midyear examinations
*Payment of fees for second semester
First semester completed, 2:00 p.m.
SEMESTER— January 28 to June 7, 1952
Instruction begins at 8:30 a.m.
Instruction suspended at 5:00 p.m.
Holiday — Washington's Birthday
Instruction resumed
Instruction suspended at 5:00 p.m.
Easter Holiday
Instruction resumed
Juniors and Seniors excused to attend annual meetings
of the Medical & Chirurgical Faculty
Junior examinations begin
Senior classes cease at 5 :00 p.m.
Junior examinations continue
Sophomore and Freshman examinations begin
Holiday — Memorial Day
Announcement of graduates
Commencement
Second Semester completed at 12:30 p.m.
PARTIAL CALENDAR FOR 1952-1953
1952
September 8, 9, 10
September 16 Tuesday
September 17 Wednesday
September 18 Thursday
Re-examinations for advancement
"Registration, payment of fees, freshmen & sophomores
N Registration, payment of fees, all other students
Instruction begins at 8:30 a.m.
* A student who fails to register prior to or within the day or days specified will be
called upon to pay a late registration fee of five dollars ($5.00) . The last day of registra-
tion with fee added to regular charges is Saturday of the week in which registration begins.
The offices of the registrar and comptroller are open daily from 9:00 A.M. to 4:00 P.M.,
and Saturday from 9:00 A.M. to 12:00 noon.
5
ORGANIZATION
THE UNIVERSITY OF MARYLAND
Harry Clifton Byrd, B.S., LL.D., D.Sc, President and Executive Officer
BOARD OF REAGENTS
Term Expires
William P. Cole, Jr., Chairman Baltimore 1958
Stanford Z. Rothschild, Secretary Baltimore 1952
J. Milton Patterson, Treasurer Baltimore 1953
B. Herbert Brown, Jr Baltimore 1960
Edward F. Holter Middletown 1959
E. Paul Knotts Denton 1954
Arthur O. Lovejoy Baltimore 1960
Charles P. McCormick Baltimore 1957
Harry H. Nuttle Denton 1957
Philip C. Turner Parkton 1959
Mrs. John L. Whitehurst Baltimore 1956
Members of the Board are appointed by the Governor of the State for terms of
nine years each, beginning the first Monday in June.
The President of the University of Maryland is, by law, Executive Officer of the
Board.
A regular meeting of the Board is held the third Friday in each month, except
during the months of July and August.
Each school has its own Advisory Board, Council, or Committee composed of
the Dean and members of its faculty, which controls the internal affairs of the
group it represents.
The University has the following educational organizations:
At Baltimore
The School of Dentistry
The School of Law
The School of Medicine
The School of Nursing
The School of Pharmacy
The College of Education
(Baltimore Division)
At College Park
The College of Agriculture
The College of Arts and Sciences
The College of Business and Public
Administration
The College of Education
The Glenn L. Martin College of
Engineering and Aeronautical
Sciences
The College of Home Economics
The Graduate School
The College of Military Science
The College of Physical Education,
Recreation and Health
The College of Special and Con-
tinuation Studies
The Summer School
ADMINISTRATIVE OFFICERS
School of Medicine
H. C. Byrd, B.S., LL.D., D.Sc President of the University
H. Boyd Wylie, M.D Dean
Alma H. Preinkert, MA Registrar
Edgar F. Long, Ph.D Director of Admissions
7
SCHOOL 0/ MEDICINE
FACULTY OF MEDICINE
EMERITI
J. M. H. Rowland, M.D., D.Sc, LL.D.
Professor of Obstetrics, Emeritus; Dean, Emeritus
Henry J. Walton, M.D Professor of Roentgenology, Emeritus
Page Edmunds, M.D Professor of Traumatic Surgery, Emeritus
Ruth Lee Briscoe Librarian, Emeritus
Albertus Cotton, M.A., M.D.. Professor of Orthopaedic Surgery, and Roentgenology,
Emeritus5
Harvey G. Beck, M.D., D.Sc Professor of Clinical Medicine, Emeritus
Irving J. Spear, M.D Professor of Neurology, Emeritus
Carl L. Davis, M.D Professor of Anatomy, Emeritus
Arthur M. Shipley, M.D., D.Sc Professor of Surgery, Emeritus
Clyde A. Clapp, M.D Professor of Ophthalmology, Emeritus
Andrew C. Gillis, M.A., M.D., LL.D Professor of Neurology, Emeritus
Edgar B. Friedenwald, M.D Professor of Clinical Pediatrics, Emeritus
ADVISORY BOARD OF THE FACULTY
Dean H. Boyd Wylie, Chairman
0. G. Harne, Secretary
George H. Buck, Ex Officio Member
William R. Amberson
James G. Arnold, Jr.
Walter A. Baetjer
Charles Bagley, Jr.
J. Edmund Bradley
Otto C. Brantigan
Raymond M. Burgison
Howard M. Bubert
T. Nelson Carey
C. Jelleff Carr
Thomas R. Chambers
Carl Dame Clarke
Richard G. Coblentz
Beverley C. Compton
Charles N. Davidson
John DeCarlo. Jr.
Louis H. Douglass
C. Redd Edwards
Monte Edwards
Frederick P. Ferguson
Frank H. J. Figge
Jacob E. Finesinger
A. H. Finkelstein
Moses Gellman
Gordon E. Gibbs
Frank W. Hachtel
Edward J. Herbst
Cyrus F. Horine
Harry C. Hull
J. Mason Hundley, Jr.
Elliott H. Hutchins
Edward S. Johnson
F. L. Jennings
Frank D. Kaltreider
James R. Karns
Walter L. Kilby
Edward A. Kitlowski
F. Edwin Knowles
Vernon E. Krahl
John C. Krantz, Jr.
Louis A. M. Krause
Kenneth D. Legge
R. W. Locher
Edward A. Looper
William S. Love, Jr.
John F. Lutz
Charles W. Maxson
Zachariah Morgan
Theodore H. Morrison
Alfred T. Nelson
H. Whitman Newell
Thomas R. O'Rourk
C. W. Peake
D. J. Pessagno
H. R. Peters
Maurice C. Pincoffs
J. Morris Reese
5 Died May 3, 1951.
SCHOOL OF MEDICINE
Charles A.
Reifschneider
Dexter L. Reimann
Harry M. Robinson, Sr.
Harry L. Rogers
Milton S. Sacks
Emil G. Schmidt
Andrew G. Smith
Dietrich C. Smith
Frederick B. Smith
William H. Smith
Hugh R. Spencer
Thomas P. Sprunt
Edward Steers
W. Houston Toulson
J. McCullough Turner
Eduard Uhlenhuth
Henry F. Ullrich
Raymond E. Vanderlinde
Allen F. Voshell
John A. Wagner
Grant E. Ward
C. Gardner Warner
Huntington Williams
Walter D. Wise
Theodore E. Woodward
Thomas C. Wolff
Robert B. Wright
George H. Yeager
Waitman F. Zinn
ADVISORY COMMITTEE OF THE FACULTY
William R. Amberson
J. Edmund Bradley
Louis H. Douglass
C. Reid Edwards
Jacob E. Finesinger
Frank W. Hachtel
O. G. Harne, Assistant
to the Dean, Secretary
J. Mason Hundley
Walter L. Kilby
F. Edwin Knowles, Jr.
John C. Krantz, Jr.
Alfred T. Nelson
Maurice C. Pincoffs
Emil G. Schmidt
Hugh R. Spencer
Eduard Uhlenhuth
H. Boyd Wylie, Dean
Chairman
FACULTY OF MEDICINE
PROFESSORS
Myron S. Aisenberg, D.D.S., Professor of Pathology, School of Dentistry.
William R. Amberson, Ph.D., Professor of Physiology, and Head of the Department.
Charles Bagley, Jr., M.A., M.D., Professor of Neurological Surgery.
Joseph C. Biddix, Jr., D.D.S., Professor of Oral Diagnosis, School of Dentistry.
J. Edmund Bradley, M.D., Professor of Pediatrics, and Head of the Department.
Otto C. Brantigan, B.S., M.D., Professor of Surgical Anatomy, Clinical and Thoracic
Surgery.
T. Nelson Carey, M.D., Professor of Clinical Medicine.
C. Jelleff Carr, Ph.D., Professor of Pharmacology.2
Richard G. Coblentz, M.A., M.D., Professor of Clinical Neurological Surgery.
Edward C. Dobbs, D.D.S., Professor of Pharmacology, School of Dentistry.
Brice M. Dorsey, D.D.S., Professor of Oral Surgery, School of Dentistry.
Louis H. Douglass, M.D., Professor of Obstetrics, and Head of the Department.
It is to be noted that for convenience of reference the names of the mem-
bers of the Faculty are listed in the forepart of this catalogue in alphabetical
order. The names are listed in order of seniority under each preclinical and
clinical department of the school on subsequent pages.
On the lists of the Faculty of Medicine and Fellows and the Hospital and Dispensary
staffs are given the names and positions assigned during the period July 1, 1951 to June 30.
1952 unless otherwise indicated. Changes are noted as follows:
1 Appointments effective July 1, 1951.
2 Promotions effective July 1, 1951.
3 Resignations.
4 Retirements.
6 Deaths.
6 Leave of absence.
10 UNIVERSITY OF MARYLAND
Charles Reid Edwards, M.D., Professor of Surgery, and Acting Head of the Department.
Monte Edwards, M.D., Clinical Professor of Surgery and Professor of Proctology.
Ray Ehrensberger, Ph.D., Professor of Speech, College of Arts and Sciences.
Lloyd D. Felton, A.B., D.Sc, M.D., Visiting Research Professor of Bacteriology.1
Frank H. J. Figge, Ph.D., Professor of Anatomy.
Jacob E. Finesinger, M.D., Professor of Psychiatry, and Head of the Department.
Grason W. Gaver, D.D.S., Professor of Dental Prosthetics, School of Dentistry.
Frank W. Hachtel, M.D., Professor of Bacteriology, and Head of the Department.
Harry C. Hull, M.D., Professor of Clinical Surgery.
J. Mason Hundley, Jr., M.A., M.D., Professor of Gynecology, and Head of the Department.
Elliott H. Hutchins, M.A., M.D., Professor of Surgery.
F. L. Jennings, M.D., Professor of Clinical Surgery.
C. Loring Joslin, M.D., Professor of Pediatrics.
Walter L. Kilby, M.D., Professor of Roentgenology, and Head of the Department.
Edward A. Kitlowski, A.B., M.D., Clinical Professor of Plastic Surgery.
John C. Krantz, Jr., Ph.D., D.Sc, Professor of Pharmacology, and Head of the Depart-
ment.
Louis A. M. Krause, M.D., Professor of Clinical Medicine.
Kenneth D. Legge, M.D., Professor of Clinical Urology.
Edward A. Looper, M.D., D.Oph., Professor of Otolaryngology, and Head of the Depart-
ment.
Theodore H. Morrison, M.D., Clinical Professor of Gastro-Enterology.
Alfred T. Nelson, M.D., Professor of Anaesthesiology, and Head of the Department.
Ernest B. Nuttall, D.D.S., Professor of Crown and Bridge, School of Dentistry.
Thomas R. O'Rourk, M.D., Professor of Otolaryngology.
D. J. Pessagno, A.B., M.D., Professor of Clinical Surgery
H. Raymond Peters, A.B., M.D., Professor of Clinical Medicine
Maurice C. Pincoffs, B.S., M.D., Professor of Medicine, and Head of the Department.
Kyrle W. Preis, D.D.S., Professor of Orthodontics, School of Dentistry.1
Kenneth V. Randolph, D.D.S., Professor of Operative Dentistry, School of Dentistry.
Charles A. Reifschneider, M.D., Clinical Professor of Traumatic Surgery.
John R. Reid, Ph.D., Visiting Professor of Psychiatry.1"
Harry L. Rogers, M.D., Clinical Professor of Orthopaedic Surgery.
Harry M. Robinson, Sr., M.D., Professor of Dermatology.
Emil G. Schmidt, Ph.D., LL.B., Professor of Biological Chemistry, and Head of the De-
partment.
Dietrich Conrad Smith, Ph.D., Professor of Physiology.
Hugh R. Spencer, M.D., Professor of Pathology, and Head of the Department.
Thomas P. Sprunt, A.B., M.D., Professor of Clinical Medicine.
W. Houston Toulson, M.Sc, M.D., Professor of Urology.
I. Ridgeway Trimble, M.D., Professor of Clinical Surgery.2
Eduard Uhlenhuth, Ph.D., Professor of Anatomy, and Head of the Department.
Allen Fiske Voshell, A.B., M.D., Professor of Orthopaedic Surgery.
Huntington Williams, M.D., Dr. P.H., Professor of Hygiene and Public Health.
Walter D. Wise, M.D., Professor of Surgery.
George H. Yeager, B.S., M.D., Professor of Clinical Surgery, and Director of Clinical
Research.
Waitman F. Zinn, M.D., Professor of Otolaryngology.
la Appointment effective Sept. 1, 1950
SCHOOL OF MEDICINE 11
ASSOCIATE PROFESSORS
Franklin R. Anderson, M.D., Associate Professor of Otolaryngology.5
Merle Ansberry, Ph.D., Associate Professor of Speech, College of Arts and Sciences.
James G. Arnold, Jr., M.D., Associate Professor of Neurological Surgery.
H. M. Bubert, M.D., Associate Professor of Medicine.
Thomas R. Chambers, A.B., M.D., Associate Professor of Surgery.
Carl Dame Clarke, Associate Professor of Art as Applied to Medicine.
Charles N. Davidson, M.D., Associate Professor of Roentgenology.
Ross Davies, M.D., Associate Professor of Hygiene and Public Health.
J. S. Eastland, M.D., Associate Professor of Medicine.
A. H. Finkelstein, M.D., Associate Professor of Pediatrics.
Russel S. Fisher, M.D., Associate Professor of Legal Medicine.1
Leon Freedom, M.D., Associate Professor of Neurology.
Frederick P. Furguson, Ph.D., Associate Professor of Physiology.2
William L. Garlick, A.B., M.D., Associate Professor of Thoracic Surgery and Associate
in Surgery.2
Moses Gellman, B.S., M.D., Associate Professor of Orthopaedic Surgery.
Gordon E. Gibbs, M.D., Associate Professor of Clinical Research.1
Lewis P. Gundry, M.D., Associate Professor of Medicine.
O. G Harne, Associate Professor of Anatomy, and Asst. to the Dean.
Hugh H. Hicks, D.D.S., Associate Professor of Periodontology, School of Dentistry.
Cyrus F. Horine, M.D., Associate Professor of Surgery.
Albert Jaffe, M.D., Associate Clinical Professor of Pediatrics.
Edward S. Johnson, M.D., Associate Professor of Surgery.
VVedon Johnson, A.B., M.D., Associate Professor of Anesthesiology.1
D. Frank Kaltreider, A.B., M.D., Associate Professor of Obstetrics.2
Fayne A. Kayser, M.D., Associate Professor of Otolaryngology.
Vernon E. Krahl, B.S., M.S., Ph.D., Associate Professor of Anatomy.
Frederick T. Kyper, M.D., D.Sc, Associate Professor of Otolaryngology.
R. W. Locher, M.D., Associate Professor of Clinical Surgery.
William S. Love, Jr., A.B., M.D., Associate Professor of Medicine.
Charles W. Maxson, M.D., Associate Professor of Surgery.
Walter C. Merkel, A.B., M.D., Associate Professor of Pathology.
Samuel Morrison, A.B., M.D., Associate Professor of Medicine, Associate Professor of
Gastro-enterology.
James W. Nelson, M.D., Associate Professor of Surgery.
H. Whitman Newell, M.D., Associate Professor of Psychiatry.
C. W. Peake, M.D., Associate Professor of Surgery.
J. Morris Reese, M.D., Associate Professor of Obstetrics.
Dexter L. Reimann, B. S., M.D., Associate Professor of Pathology.
Benjamine S. Rich, A.B., M.D., Associate Professor of Otolaryngology.
Ida M. Robinson, A.B., B.S.L.S., Associate Professor of Library Science.
Milton S. Sacks, M.D., Associate Professor of Medicine and Head of Clinical Pathology,
Associate in Pathology.
Frederick B. Smith, M.D., Associate Professor of Pediatrics.
William H. Smith, M.D., Associate Professor of Clinical Medicine.
Edward Steers, Ph.D., Associate Professor of Bacteriology.
Lewis C. Toomey, D.D.S., Associate Professor of Oral Surgery, School of Dentistry.
5 Died Jan. 23, 1951.
12 UNIVERSITY OF MARYLAND
J. McCullough Turner, Ph.D., Associate Professor of Physiology.2
Henry F. Ullrich, M.D., D.Sc, Associate Professor of Orthopaedic Surgery
John A. Wagner, B.S., M.D., Associate Professor of Pathology.
W. Wallace Walker, M.D., Associate Professor of Surgery and Surgical Anatomy.
Grant E. Ward, A.B., M.D., Associate Professor of Surgery and Oral Surgery.3
C. Gardner Warner, A.B., M.D., Associate Professor of Pathology.
William H. F. Warthen, A.B., M.D., Associate Professor of Hygiene & Public Health.
T. Conrad Wolff, M.D., Associate Professor of Medicine, and Head of the Division of
Physical Diagnosis.
Theodore E. Woodward, M.D., Associate Professor of Medicine
Robert B. Wright, B.S., M.D., Associate Professor of Pathology.
ASSISTANT PROFESSORS
Thurston R. Adams, M.D., Assistant Professor of Surgery and Proctology.
Donald J. Barnett, M.D., Assistant Professor of Roentgenology.
H. F. Bongardt, M.D., Assistant Professor of Surgery.
Leo Brady, A.B., M.D., Assistant Professor of Gynecology.
Simon H. Brager, M.D., Assistant Professor of Surgery and Proctology.
Raymond M. Burgison, Ph.D., Assistant Professor of Pharmacology.1*
Beverley C. Compton, A.B., M.D., Assistant Professor of Gynecology.
Ernest I. Cornbrooks, Jr., A.B., M.D., Assistant Professor of Gynecology.
Edward F. Cotter, M.D., Assistant Professor of Medicine, Associate in Neurology.
J. G. N. Cushing, M.D., Assistant Professor of Psychiatry.
John DeCarlo, A.B., M.D., Assistant Professor of Roentgenology.
William K. Diehl, M.D., Assistant Professor of Gynecology.
Everett S. Diggs, B.S., M.D., Assistant Professor of Gynecology.
John S. Dumler, B.S.; M.D., Assistant Professor of Gynecology.
William W. Elgin, M.D., Assistant Professor of Psychiatry.
Francis A. Ellis, A.B., M.D., Assistant Professor of Dermatology.
Maurice Feldman, M.D., Assistant Professor of Gastro-Enterology.
Jerome Fineman, M.D., Assistant Professor of Pediatrics.
Wetherbee Fort, M.D., Assistant Professor of Medicine.
Frank J. Geraghty, A.B., M.D., Assistant Professor of Medicine.
Francis W. Gillis, M.D., Assistant Professor of Urology.
Samuel S. Glick, M.D., Assistant Professor of Pediatrics.
Albert E. Goldstein, M.D., Assistant Professor of Pathology.
George Govatos, A.B., M.D., Assistant Professor of Surgery.
Robert G. Grenell, B.A., M.Sc, Ph.D., Assistant Professor Psychiatric Research.2
Edward J. Herbst, Ph.D., Assistant Professor of Biological Chemistry.
John F. Hogan, M.D., Assistant Professor of Urology.
F. Edwin Knowles, Jr., M.D., Assistant Professor of Ophthalmology and Chairman
of the Department.
H. Vernon Langeluttig, M.D., Assistant Professor of Medicine.
C. Edward Leach, M.D., Assistant Professor of Medicine.
Philip L. Lerner, M.D., Assistant Professor of Neurology.
Ephriam T. Lisansky, M.D., Assistant Professor of Medicine and Associate in Psy-
chiatry.2
Hans W. Loewald, M.D., Assistant Professor of Psychiatry.
la Appointment effective Sept., 1, 1950.
SCHOOL OF MEDICINE 13
John F. Lutz, A.B., M.D., Assistant Professor of Anatomy.
Henry J. L. Marriott, A.M., B.M., Assistant Professor of Medicine.
Howard B. Mays, M.D., Assistant Professor of Genito-Urinary Surgery and Instructor in
Urology and Pathology.
W. Raymond McKenzie, M.D., Assistant Professor of Otolaryngology.
Karl F. Meek, B.S., M.D., Assistant Professor of Anatomy.2
Zachariah Morgan, M.D., Assistant Professor of Gastro-Enterology.
Hugh B. McNally, B.S., M.D., Assistant Professor of Obstetrics.
Harry M. Murdock, B.S., M.D., Assistant Professor of Psychiatry.
George McLean, M.D., Assistant Professor of Medicine.
M. Alexander Novey, A.B., M.D., Assistant Professor of Obstetrics.
Samuel T. R. Revell, Jr., M.D., Assistant Professor of Medicine.
I. O. Ridgely, M.S., M.D., Assistant Professor of Surgery.
William F. Rienhoff, M.D., Assistant Professor of Surgery.
Robert A. Reiter, M.D., Assistant Professor of Medicine.2
Harry M. Robinson, Jr., B.S., M.D., Assistant Professor of Dermatology, Associate in
Medicine.
Irving Rothchild, Ph.D., Assistant Professor of Physiology.
John E. Savage, B.S., M.D., Assistant Professor of Obstetrics.
Kathyrn L. Schultz, M.D., Assistant Professor of Psychiatry.
Theodore A. Schwartz, M.D., Assistant Professor of Otolaryngology.
William M. Seabold, M.D., Assistant Professor of Pediatrics.
William B. Settle, M.D., Assistant Professor of Surgical Anatomyand Associate in Surgery.
Isadore A. Siegel, A.B., M.D., Assistant Professor of Obstetrics.
Arthur G. Siwinski, A.B., M.D., Assistant Professor of Surgery.2
Andrew G. Smith, Ph.D., Assistant Professor of Bacteriology.
Edward P. Smith, M.D., Ph.G., Assistant Professor of Gynecology.
Sol Smith, M.D., Assistant Professor of Medicine.
Isidore William Towlen, M.D., Assistant Professor of Anesthesiology.
Raymond E. Vanderlinde, A.B., Ph.D., Assistant Professor of Biological Chemistry.
Philip S. Wagner, M.D., Assistant Professor of Psychiatry.
Gibson J. Wells, M.D., Assistant Professor of Pediatrics.
Milton J. Wilder, M.D., Assistant Professor of Orthopedic Surgery.
ASSOCIATES
Conrad B. Acton, M.D., Associate in Medicine.
Marie A. Andersch, Ph.D., Associate in Medicine.
Leon Ashman, B.S., M.D., Associate in Medicine.2
J. Tyler Baker, B.S., M.D., Associate in Obstetrics.
Margaret B. Ballard, M.D., Associate in Obstetrics.
Charles P. Barnett, A.B., M.D., Associate in Pathology.
Edmund G. Beacham, M.D., Associate in Medicine.
Eugene S. Bereston, A.B., M.D., Associate in Dermatology.
Robert Z. Berry, A.B., M.D., Associate in Otolaryngology.2
Louis V. Blum, M.D., Associate in Medicine.2
Harry C. Bowie, B.S., M.D., Associate in Surgical Anatomy.
Kenneth B. Boyd, A.B., M.D., Associate in Gynecology.
Frank J. Brady, M.D., Associate in Anaesthesiology.
Henry A. Briele, M.D., Associate in Postgraduate Surgery.1
V. V. Brunst, Sc.D., Research Associate in Anatomy.
14 UNIVERSITY OF MARYLAND
William R. Bundick, M.D., Associate in Dermatology.2
Harold H. Burns, M.D., Associate in Surgery.
M. Paul Byerly, M.D., Associate in Medicine.
Richard A. Carey, M.D., Associate in Medicine.
Osborne D. Christensen, M.D., Associate in Obstetrics.
Jonas Cohen, M.D., Associate in Medicine.2
Edward R. Dana, A.B., M.D., Associate in Roentgenology.
Kathryn Dice, Ed.D., Associate in Clinical Psychology.
Francis G. Dickey, M.D., Associate in Medicine.
D. McClelland Dixon, M.D., Associate in Obstetrics and Instructor in Pathology.
Stanley H. Durlacher, M.D., Associate in Legal Medicine.
J. J. Erwin, M.D., Associate in Gynecology.
L. K. Fargo, M.D., Associate in Urology.
William L. Fearing, M.D., Associate in Neurology.3
Donald E. Fisher, M.D., Associate in Pathology.
William H. Fisher, M.D., Associate in Postgraduate Surgery.1
Irving Freeman, M.D., Associate in Medicine.
Henry C. Freimuth, Ph.D., Associate in Legal Medicine.
John S. Haines, M.D.,2 Associate in Urology.
Alvin J. Hartz, A.B., M.D., Associate in Medicine.
Raymond F. Helfrich, A.B., M.D., Associate in Surgery.
W. Grafton Herspberger, M.D., Associate in Medicine.
John T. Hibbitts, M.D., Associate in Gynecology.
Henry W. D. Holljes, M.D., Associate in Medicine.
Z. Vance Hooper, M.D., Associate in Gastro-Enterology.
Clewell Howell, B.S., M.D., Associate in Pediatrics.
Benjamin H. Isaacs, A.B., M.D., Associate in Otolaryngology.
Meyer W. Jacobson, M.D., Associate in Medicine.
Joseph V. Jerardi, B.S., M.D., Associate in Surgery.
Hugh J. Jewett, M.D., Associate in Urology.
Arthur Karfgin, B.S., M.D., Associate in Medicine.
Walter Karfgin, M.D., Associate in Medicine.
James R. Karns, B.S., M.D., Associate in Medicine, and Physician in Charge of Medical
Care of Medical Students.2
Joseph I. Kemler, M.D., Associate in Ophthalmology.
Albert W. Kitts, M.D., Associate in Postgraduate Pediatrics.10
Louis B. Kroll, A.B., M.D., Associate in Medicine.2
Elizabeth LaForge, M.S.S., Associate in Psychiatric Social Work.
Samuel Legum, M.D., Associate in Medicine.
H. Edmund Levin, M.D., Associate in Bacteriology.
Kurt Levy. M.D., Associate in Medicine.
William B. Long, M.D., Associate in Postgraduate Surgery.1
H. Patterson Mack, M.D., Associate in Anatomy.2
G. Bowers Mansdorfer, B.S., M.D., Associate in Pediatrics.
I. H. Maseritz, M.D., Associate in Orthopaedic Surgery.
William J. McClafferty, M.D., Associate in Legal Medicine.lb
George G. Merrill, M.D., Associate in Neurology.
Moritz Michaelis, Ph.D., Research Associate in Psychiatry.18
Effective appointment dates: Associates
^Nov. 1, 1950.
lbJan. 25, 1951.
lcJan. 5, 1951.
SCHOOL OF MEDICINE 15
Lyle J. Millan, M.D., Associate in Urology.
Frank K. Morris, A.B., M.D., Associate in Gynecology.
J. Huff Morrison, B.S., M.D., Associate in Obstetrics.2
S. Edwin Muller, M.D., Associate in Medicine.
Patrick C. Phelan, Jr., A.B., M.D., Associate in Anatomy.2
Ross Z. Pierpont, M.D., Associate in Surgical Anatomy, and Assistant in Surgery.
Herbert E. Reifschneider, A.B., M.D., Associate in Surgery and Surgical Anatomy.
R. C. V. Robinson, M.D., Associate in Dermatology.
Sidney Scherlis, M.D., Associate in Medicine.
William M. Seabold, A.B., M.D., Associate in Pediatrics.
Lawrence M. Serra, M.D., Associate in Medicine.
A. Albert Shapiro, B.S., M.D., Associate in Dermatology.
Benedict Skitarelic, A.B., M.D., Associate in Pathology.
Edward H. Stewart, Jr., M.D., Associate in Surgery.2
Harry A. Teitlebaum, B.S., M.D., Ph.D., Associate in Neurology.
Raymond K. Thompson, B.S., M.D., Associate in Neurosurgery, and Director of Neuro-
logical Research.2
Wilfred H. Townshend, Jr., A.B., M.D., Associate in Medicine.
Isadore Tuerk, M.D., Associate in Psychiatry.
William K. Waller, M.D., Associate in Medicine.
Arthur Ward, M.D., Associate in Otolaryngology.2
Daniel Wilfson, Jr., A.B., M.D., Associate in Medicine.2
Austin H. Wood, M.D., Associate in Urology.
Israel Zeligman, A.B., M.D., Associate in Dermatology.
LECTURERS
Harold E. Himwich, M.D., Lecturer in Physiology and Psychiatry.1*
Amedeo S. Marrazzi, M.D., Lecturer in Pharmacology.
Joseph M. Miller, M.D., Lecturer in Surgery.
William H. Summerson, Ph.D., Lecturer in Biological Chemistry.
INSTRUCTORS
A. Russell Anderson, M.D., Instructor in Psychiatry.
Robert E. Bauer, A.B., M.D., Instructor in Medicine.
Harry McB. Beck, M.D., Instructor in Gynecology, and Assistant in Obstetrics.1
Joseph G. Bird, A.B., M.D., Instructor in Medicine.2
Thomas S. Bowyer, A.B., M.D., Instructor in Gynecology and Assistant in Obstetrics.
John T. Bracken, B.S., M.D., Instructor in Roentgenology.lb
Charles E. Brambel, A.M., Ph.D., Instructor in Medicine.
George H. Brouillet, B.S., M.D., Instructor in Surgery.
Ann Virginia Brown, A.B., Instructor in Biological Chemistry.
J. E. Brumback Jr., B.S., M.D., Instructor in Ophthalmology.
William J. Bryson, A.B., M.D., Instructor in Pathology.
Lucile J. Caldwell, M.D., Instructor in Dermatology.
Enoch Calloway, Jr., A.B., M.D., Instructor in Psychiatry.
Joseph P. Cappuccio, D.D.S., Instructor in Oral Surgery, School of Dentistry.
John W. Chambers, M.D., Instructor in Neurosurgery, Assistant in Surgery.2
Effective appointment date: Lecturers.
18 Nov. 1, 1950.
Effective appointment date: Instructors.
lbDec. 1,1950.
16 UNIVERSITY OF MARYLAND
Thomas A. Christensen, A.B., M.D., Instructor in Pediatrics.
Morris M. Cohen, M.D., Instructor in Dermatology.
Joseph M. Cordi, M.D., Instructor in Pediatrics.
Richard J. Cross, B.S., M.D., Instructor in Ophthalmology, and Otolaryngology.6
Raymond M. Cunningham, A.B., M.D., Instructor in Anatomy and Proctology, Assistant
in Surgery.
George H. Davis, B.S., M.D., Instructor in Obstetrics.2
John R. Davis, M.D., Instructor in Medicine.
W. Allen Deckert, A.B., M.D., Instructor in Gynecology and Assistant in Surgery.
John B. DeHoff, M.D., Instructor in Medicine.
John M. Dennis, B.S., M.D., Instructor in Roentgenology.1
William A. Dodd, M.D., Instructor in Gynecology, and Assistant in Obstetrics.
Charles H. Doeller, Jr., A.B., M.D., Instructor in Gynecology, and Assistant in Obstetrics.
William C. Duffy, A.B., M.D., Instructor in Gynecology.
Ernest S. Edlow, A.B., M.D., Instructor in Gynecology.
Maurice Feldman, Jr., A.B., M.D., Instructor in Medicine.2
Maurice Fine, M.D., Instructor in Medicine.2
Philip D. Flynn, M.D., Instructor in Medicine.
Samuel L. Fox, Ph.G., B.S., M.D., Instructor in Physiology, and Associate in Otolaryn-
gology.
Paul N. Friedman, A.B., M.D., Instructor in Ophthalmology.
Audry M. Funk, A.B., Instructor in Medicine.
Joseph E. Furnari, M.D., Instructor in Medicine.2
Perry O. Futterman, A.B., M.D., Instructor in Medicine.
L. Calvin Gareis, B.S., M.D., Instructor in Pathology, and Obstetrics, Assistant in
Gynecology.
Jason H. Gaskel, M.D., Instructor in Orthopaedic Surgery.
H. L. Granoff, A.B., M.D., Instructor in Gynecology.
Isaac Gutman, Instructor in Orthopaedic Surgery.
Samuel J. Hankin, M.D. Instructor in Medicine.
Charles W. Hawkins, M.D., Instructor in Anatomy.6
Mary L. Hayleck, M.D., Instructor in Pediatrics.
Robert F. Healy, M.D., Instructor in Surgery.
Donald B. Hebb, M.D., Instructor in Proctology and Assistant in Surgery.
William G. Helfrich, B.S., M.D., Instructor in Medicine.
L. Ann Hellen, B.S., Instructor in Medicine.
Mark B. Hollander, A.B., M.D., Instructor in Dermatology and Syphilology.
Calvin Hyman, M.D., Instructor in Surgery.
Conrad L. Inman, D.D.S., Instructor in Anesthesiology, School of Dentistry.
Marshall I. Kacler, D.D.S., Instructor in Oral Surgery, School of Dentistry.
Edward S. Kallins, B.S., M.D., Instructor in Medicine.
William H. Kammer, Jr., A.B., M.D., Instructor in Medicine.
Harry F. Kane, M.D., Instructor in Gynecology.
Theodore Kardash, B.S., M.D., Instructor in Gynecology and Pathology.
Clyde F. Karns, B.S., M.D., Instructor in Surgery.
Irvin B. Kemick, B.S., Ph.G., M.D., Instructor in Medicine.2
Leon A. Kochman, M.D., Instructor in Medicine.
Schuyler G. Kohl, B.S., M.D., Instructor in Obstetrics.
Edward L. J. Kreig, M.D., Instructor in Pathology.1
A. Kremen, A.B., M.D., Instructor in Ophthalmology.
Arnold F. Lavenstein, Instructor in Pediatrics.
Algert P. Lazauskas, D.D.S., Instructor in Oral Surgery, School of Dentistry.
SCHOOL OF MEDICINE 17
V. Harwood Link, M.D., Instructor in Dermatology.
F. Ford Loker, B.S., M.D., Instructor in Surgery.
Helen I. Maginnis, M.D., Instructor in Gynecology.
Louis O. J. Manganiello, A.B., M.D., Instructor in Anatomy,1 Research Fellow, Neuro-
surgery.3
Charles B. Marek, M.D., Instructor in Gynecology.
Marion W. Mathews, A.B., M.S., M.D., Instructor in Psychiatry.
Robert E. McCafferty, B.S., M.S., M.D., Instructor in Anatomy.18
Francis J. McLaughlin, M.D., Instructor in Psychiatry.
D. J. McHenry, B.S., M.D., Instructor in Ophthalmology.6
Jose" Medina, D.D.S., Instructor in Oral Surgery, School of Dentistry.
Israel P. Meranski, B.S., M.D., Instructor in Pediatrics.
James P. Miller, M.D., Instructor in Orthopaedic Surgery.10
J. Duer Moores, B.S., M.D., Instructor in Surgery.
Joseph E. Muse, Jr., B.S., M.D., Instructor in Medicine.
Ruth Musser, M.S., Instructor in Pharmacology.
John A. Myers, M.E.E., M.D., Instructor in Medicine, Assistant in Gastro-Enterolngy.
James J. Nolan, B.S., M.D., Instructor in Medicine.2
Samuel Novey, M.D., Instructor in Psychiatry.
Frank J. Otenasek, M.D., Instructor in Neuro-Surgery.2
Robert T. Parker, A.B., M.D., Instructor in Medicine.1
Samuel E. Proctor, A.B., M.D., Instructor in Surgery.
J. Emmett Queen, M.D., Instructor in Medicine.
Martin A. Robbins, M.D., Instructor in Urology.1
Daniel R. Robinson, M.D., Instructor in Surgery.
Seymour W. Rubin, M.D., Instructor in Pathology.
William J. Rysanek, Jr., M.D., Instructor in Gynecology.
Clarence P. Scarborough, M.D., Instructor in Surgery.
John F. Schaefer, B.S., M.D., Instructor in Surgery.
J. King B. E. Seegar, Jr., A.B., M.D., Instructor in Obstetrics.
Charles E. Shaw, M.D., Instructor in Medicine.2
Joseph C. Sheehan, B.S., M.D., Instructor in Gynecology 6
Robert C. Sheppard, M.D., Instructor in Surgery.
Jerome Sherman, M.D., Instructor in Medicine.2
Elizabeth D. Sherrill, M.D., Instructor in Medicine.2
E. Roderick Shipley, A.B., M.D., Instructor in Surgery.
Albert J. Shochat, B.S., M.D., Instructor in Gastro-Enterology.
George W. Smith, B.S., M.D., Instructor in Anatomy, Assistant in Neuro-Surgery.1
Ruby A. Smith, B.S., M.D., Instructor in Ophthalmology.
Merrill J. Snyder, B.S., Instructor in Bacteriology.
Melchijah Spragins, B.S., M.D., Instructor in Pediatrics.
Stuart D. Sunday, M.D., Instructor in Medicine.2
William T. Supik, M.D., Instructor in Proctology.
Robert B. Tunney, A.B., M.D., Instructor in Gynecology.
Roy B. Turner, B.S., M.D., Instructor in Pathology,1 and Neuro-Anatomy.ld
William D. VandeGrift, M.D., Instructor in Pathology.
Effective appointment dates: Instructors.
18 Appointment Effective Aug. 1, 1951.
3 Resigned April 30, 1951.
lc Oct. 5, 1950.
ldFeb. 1, to June 1, 1951.
18 UNIVERSITY OF MARYLAND
Edmond G. Vanden Bosche, D.D.S., Instructor in Oral Surgery, School of Dentistry.
Stephen J. Van Lill, III, A.B., M.D., Instructor in Medicine.2
Frederick J. Vollmer, B.S., M.D., Instructor in Medicine.
Gladys E. Wadsworth, B.S., M.A., Instructor in Anatomy.ld
Charles Herman Williams, M.D., Instructor in Medicine.1
Frederick S. Wolf, M.D., Instructor in Neurology.le
John D. Young, Jr., M.D., Instructor in Urology.1
ASSISTANTS
Robert C. Abrams, M.D., Assistant in Orthopaedic Surgery.10
Fred B. Agee, M.D., Assistant in Medicine.1
Jose A. Alvarez, M.D., Assistant in Neurological Surgery.
A. Maynard Bacon, Jr., B.S., M.D., Assistant in Pediatrics.6
Ruth W. Baldwin, M.D., Assistant in Pediatrics and Director of the Pediatrics Seizure
clinic.1
Thomas G. Barnes, M.D., Assistant in Surgery.1
Harry McB. Beck, A.B., M.D., Assistant in Obstetrics.
Walter J. Benavent, B.S., M.D., Assistant in Plastic Surgery.
Harold P. Biehl, M.D., Assistant in Surgery.1
Jane L. Bleakley, Assistant in Art as Applied to Medicine.
Jenifred S. Boehm, A.B., Assistant in Art as Applied to Medicine.
Melvin M. Borden, M.D., Assistant in Pediatrics.1
Frances C. Brown, A.B., Assistant in Physiology.
A. V. Buchness, A.B., M.D., Assistant in Surgery.
Bernard Burgin, A.B., M.D., Assistant in Medicine.1
Lester H. Caplan, M.D., Assistant in Pediatrics.
L. T. Chance, M.D., Assistant in Surgery.
James N. Cianos, M.D., Assistant in Surgery.
Raymond J. Clayton, Jr., Assistant in Art as Applied to Medicine.
Harry Cohen, B.S., M.D., Assistant in Obstetrics and Pathology.1
Sarah Cook, A.B., M.D., Assistant Director Post Graduate Medicine, and Assistant in
Pediatrics.
Donald D. Cooper, M.D., Assistant in Pediatrics.3
R. Adams Cowley, M.D., Assistant in Thoracic Surgery and Assistant Director Surgical
Research.1
Samuel H. Culver, M.D., Assistant in Surgery.
Martha Curtis, B.S., R.N., Assistant and Assistant Director, Medical Care Clinic. le
E. Hollister Davis, A.B., M.D., Assistant in Anaesthesia.
Patricia Dawson, Assistant in Art as Applied to Medicine.3
Michael L. DeVincentis, B.S., M.D., Assistant in Surgery.
William A. Dodd, B.S., M.D., Assistant in Obstetrics.'
William C. Dunnigan, A.B., M.D., Assistant in Surgery.
Effective appointment dates: Instructors.
ld Oct. 1, 1950— June 30, 1951
le Sept. 15, 1950.
Effective appointment dates; Assistants.
lc Oct. 1, 1950.
^Jan. 1,1951.
SCHOOL OF MEDICINE 19
Shirley K. Fitzgerald, Assistant in Art as Applied to Medicine.18
William N. Fitzpatrick, B.S., M.D., Assistant in Psychiatry.
Marjorie R. Fleitzer, M.S.S., Assistant in Psychiatric Social Work.lc
Joseph B. Ganey, M.D., Assistant in Surgery.1
Richard M. Garrett, M.D., Assistant in Surgery and Surgical Anatomy.1
William R. Geraghty, B.S., M.D., Assistant in Surgery.
Marvin Goldstein, A.B., M.D., Assistant in Medicine.1
Caridad E. Gonzalez, M.D., Assistant in Pediatrics.3
Howard Goodman, M.D., Assistant in Pediatrics.1
Donald B. Hebb, A.B., M.D., Assistant in Thoracic Surgery.1
John H. Hirschfeld, M.D., Assistant in Otolaryngology.
Hermione Hunt Hawkins, M.A., Assistant in Clinical Psychology .ld
Sylvia Himmelfarb, A.B., Assistant in Physiology.
John V. Hopkins, M.D., Assistant in Orthopaedic Surgery.
Rollin C. Hudson, M.D., Assistant in Medicine.
Henry K. Jarrett, M.D., Assistant in Urology.1
Everett D. Jones, M.D., Assistant in Orthopaedic Surgery.
Arthur Kandel, M.S., Assistant in Clinical Psychology.16
Vernon C. Kelley, A.B., M.D., Assistant in Obstetrics.lb
Lauriston L. Keown, M.D., Assistant in Medicine.
Irvin P. Klemkowski, B.S., M.D., Assistant in Obstetrics.
Raymond M. Lauer, M.D., Assistant in Medicine.1
Alfred S. Lederman, Assistant in Gastro-Enterology.
Lee R. Lerman, M.D., Assistant in Dermatology.1
Frank E. Leslie, A.B., M.D., Assistant in Medicine.
Berton V. Lock, M.D., Assistant in Medicine.1
William D. Lynn, A.B., M.D., Assistant in Surgery and Assistant Director Surgical
Research.3
W. Kenneth Mansfield, Jr., M.D., Assistant in Obstetrics.
Clarence W. Martin, M.D., Assistant in Obstetrics.
Howard B. McElwain, M.D., Assistant in Surgery.
Donald W. Mintzer, M.D., Assistant in Medicine.1
Carl A. Myers, A.B., M.D., Assistant in Medicine.1
Joseph C. Myers, M.D., Assistant in Medicine.1
Pomeroy Nichols, Jr., M.D., Assistant in Neurological Surgery.
John C. Osborne, M.D., Assistant in Medicine.
John C. Ozazewski, M.D., Assistant in Ophthalmology.1
Ross Z. Pierpont, M.D., Assistant in Surgery.
Susan R. Pincoffs, R.N., Assistant in Medicine.
Hazel Y. Pruitt, Assistant in Bacteriology.3
Jeanne Ann Quinlin, A.B., Assistant in Physiology.111
James H. Ramsey, M.D., Assistant in Pathology.1
Effective appointment dates; Assistants.
18 Feb. 26, 1951.
lbFeb. 1, 1951.
10 Oct. 1,1950.
ldNov. 1,1950.
16 Jan. 1, 1951.
lh Sept. 16, 1951.
20 UNIVERSITY OF MARYLAND
James Russo, M.D., Assistant in Anaesthesiology.
O. Walter Spurrier, M.D., Assistant in Pediatrics.
Vesta May Stevens, M.S.S., Assistant in Psychiatric Social Work.lf
Thomas McClelland Stevenson, Assistant in Art as Applied to Medicine.
T. J. Touhey, M.D., Assistant in Surgery.
William Earl Weeks, M.D., Assistant in Pediatrics.
Jack Wexler, A.B., M.D., Assistant in Medicine.
J. Carlton Wich, B.S., M.D., Assistant in Pediatrics.
Marcella Wiseman, M.S.S., Assistant in Psychiatric Social Work.
Geraldine F. Wolfe, B.S., M.S., Assistant in Anatomy.1*
Thomas Worsley, M.D., Assistant in Medicine.
Howard L. Zupnik, M.D., Assistant in Surgery.
FELLOWS
Charles P. Barnett, A.B., M.D., Baltimore Rh Typing Laboratory Fellow in Medicine.1
Frederick K. Bell, Ph.D., Fellow in Pharmacology.
George W. Bradford, M.D., Baltimore Rh Laboratory, Fellow in Medicine.
Leonard S. Brahen, B.S., M.S., Eli Lilly Fellow in Pharmacology11 -
James S. Browne, M.D., Fellow in Neurosurgery.
Robert S. Cato, A.B., M.D., Fellow in Roentgenology.6
Robert M. N. Crosby, M.D., Fellow in Neuro. Surgery.6
Ruth Page Edwards, A. B., A. M. Ph.D., Fellow in Psychology.1'
Richard F. C. Egan, M.S., John F. B. Weaver Fellow in Physiology.1
Frank A. Faraino, B.S., M.D., Fellow in Thoracic Surgery.
Mary S. Fassel, A.B., Fellow in Pharmacology.
Martin K. Gorten, M.D., Baltimore Rh Typing Laboratory Fellow in Medicine.1
John B. Harmon, B.S., Emerson Fellow in Pharmacology.
Dorothy H. Hubbard, A.B., M.S., Research Corporation Fellow in Biological Chemistry.1
Dewitt T. Hunter, John F. B. Weaver Fellow in Anatomy.
Marvin Jaffee, M.D., Fellow in Psychiatry.lb
Theodore Kardash, B.S., M.D., Research Fellow in Gynecological Pathology.10
Frederick Go-Kiatsu, B.S., M.D., Fellow in Pediatrics.
Gerald Kessler, B.S., Nutrition Foundation Fellow in Biological Chemistry.1
Robert G. Leonard, B.S., M.S., Bressler Reserved Fund Fellow in Biological Chemistry.11
Johnson S. L. Ling, A.B., M.S., Eli Lilly Fellow in Pharmacology.1'
William E. Loechel, U. S. Public Health Fellow in Medical Art.ld
Go Lu, M.D., Fellow in Pharmacology.lk
Louis 0. J. Manganiello, A.B., M.D., Fellow in Neurosurgery.3
Arlie R. Mansberger, Jr., M.D., Research Fellow in Surgery.
Eugene R. McNinch, M.D., Fellow in Roentgenology.1"
Effective appointment date: Assistants.
lf Sept. 15, 1950.
••Feb. 1, 1951.
Effective appointment dates; Fellows.
lb Sept. 15, 1950.
lcMay 1, to Aug. 31, 1951.
ld Oct. 1, 1950 to Sept. 30, 1951.
^Nov. 1,1951.
11 Sept. 1, 1951.
lk Sept. 1, 1951 to Aug. 31, 1952.
SCHOOL OF MEDICINE 21
A. Gibson Packard, A.B., John F, B. Weaver Fellow in Anatomy.1*
Sim Penton, M.D., Fellow in Thoracic Surgery.1'
Gerardo B. Polanco, M.D., National Cancer Institute Traieee in Pathology.1
J. Pomeroy Nichols, M.D., Fellow in Neurological Surgery.
James H. Shell, B.S., M.D., Hitchcock Fellow in Gynecology.1
George W. Smith, M.D., Hitchcock Fellow in Neurosurgery.1
Thomas A. Stebbins, A.B., Medical Illustrator in Gynecology.
Virginia Suttonfield, M.D., Fellow in Psychiatry.16
Edward B. Truitt, B.S., Fellow American Foundation for Pharmaceutical Education.1
Roy B. Turner, M.D., Fellow in Neurosurgery.111
Robert T. Walker, M.D., Fellow in Medicine.
Annemarie Weber, U.S.P.H., Fellow in Physiology.1*1
John I. White, Ph.D., U.S.P.H., Fellow in Physiology.lb
Joseph B. Workman, A. B., M.D., Research Fellow in Medicine.1
CONSULTANTS
Robert W. Swain, B.S., Consultant in Radiologic Physics.la
RESEARCH ASSISTANTS
Maryanne E. Berger, Research Assistant in Anatomv.1
Richard E. Brown, B.S., Research Assistant in Bacteriology.1
Catherine S. Brunst, A.B., Research Assistant in Anatomy.
Betty J. Fax, Ph.D., Research Assistant in Psychiatry. lb
Eleanor G. B. Glinos, A.B., Research Assistant in Biological Chemistry.1"1
William McKendre Headley, B.S. Research Assistant in Neurosurgery.11
Carolyn F. Hendrickson, B.S., Research Assistant in Physiology. ld
Earnest C. Herrmann, Jr., B.S. Research Assistant in Bacteriology.1*
Robert C. Holcombe, A.B., Research Assistant in Pharmacology.11
Bernard Kramer, A.B., Research Assistant in Bacteriology.1
Anne McNicholas Laster, A.B., Research Assistant in Pediatrics.10
Joseph R. Merkel, B.S., Research Assistant in Bacteriology1
Carolyn Mae Miller, A.B., Research Assistant in Psychiatry.1
Irwin H. Moss, A.B., Research Assistant in Medicine.16
Jean D. Nimmo, A.B., Research Assistant in Biological Chemistry.
John Walker Powell, Ph.D., Research Assistant in Psychiatry.1
Jeannette F. Rayner, Research Assistant in Psychiatry.
Elizabeth R. Steele, A.B., Research Assistant in Anatomy."
Carolyn M. Stout, M.S., Research Assistant in Physiology.1'
Effective appointment dates; Fellows.
11 Oct. 1, 1950.
lh April 16, 1951.
Effective appointment dates: Consultants.
laOct. 1, 1951.
Effective appointment dates: Research Assistants.
ta Feb. 1, 1951.
lb Jan. 1, 1951.
lc June 7, 1951 to Apr. 30, 1952.
ld April 1, 1951.
" Jan. 15, 1951.
* June 1, to July 31; Sept. 1 ,to Sept. 15, 1951.
11 Aug. 31, 1951.
« Junel, to July 31, 1951.
11 July 16, 1951.
22 UNIVERSITY OF MARYLAND
Barbara Elizabeth Todd, A.B., Research Assistant in Psychiatry.1'
Albert L. Tucker, A.B., Research Assistant in Pediatrics.111
Margaret Lucille Ward, A.B., M.SS., Research Assistant in Pediatrics.111
Amy Lee Wells, R.N., Research Assistant in Gynecological Pathology.1™
David Willenson, M.S., Research Assistant in Psychology.16
Richard A. Young, M.D., Research Assistant in Pediatrics.115
EXTRAMURAL ASSISTANT RESIDENTS IN MEDICINE
John F. Benson, M.D., Assistant Resident in Medicine.
Robert H. Hahn, M.D., Rotating Assistant Resident in Medicine.
Howard E. Hall, M.D., Assistant Resident in Medicine.
John A. Hightower, M.D., Rotating Assistant Resident in Medicine.
William Roemmich, M.D., Assistant Resident in Medicine.
Sidney J. Venable, M.D., Assistant Resident in Medicine.
UNIVERSITY HOSPITAL
George H. Buck, Director
James L. Dack, Asst. Director
Kurt H. Nork, Asst. Director
EXECUTIVE COMMITTEE OF THE STAFF
Edward F. Cotter, Chairman
Francis G. Dickey, Secretary-Treasurer
J. Edmund Bradley Walter L. Kilby
Louis H. Douglass F. Edwin Knowles, Jr.
Charles Redj Edwards Alfred T. Nelson
Jacob E. Finesinger Maurice C. Pincoffs
J. Mason Hundley, Jr. Milton S. Sacks
George H. Yeager
Elected Members Term Expires
A. H. FlNKELSTEIN 1951
Ephraim T. Lisansky 1951
James G. Arnold, Jr 1952
Ernest I. Cornbrooks, Jr 1952
Everett G. Diggs 1953
William G. Helfrich 1953
George H. Buck, Director, University Hospital]
}Ex officio members
H. Boyd Wylie, Dean, School of Medicine
Effective appointment dates: Research Assistants.
le Sept. 1, 1950.
lh June 15, to Aug. 31, 1951.
lk Aug. 1, to Dec. 1, 1951.
11 July 16, 1951.
toMay 1 to Aug. 31, 1951.
lD Sept. 1, 1951.
SCHOOL OF MEDICINE
23
UNIVERSITY HOSPITAL STAFF
Physicians .
Neurologists .
Pkysician-in-Chief Maurice C. Pincoffs
Thomas P. Sprunt
T. Nelson Carey
Louis A. M. Krause
William S. Love, Jr.
Howard M. Bubert
Milton S. Sacks
Lewis P. Gundry
Samuel Morrison
Thedore E. Woodward
Frank J. Geraghty
Edward F. Cotter
C. Edward Leach
Ephraim T. Lisansky
^Samuel T. R. Revell, Jr.
Irving J. Spear
Leon Freedom
William Fearing
Edward F. Cotter
George Merrill
Dermatologist-in-Chief Harry M. Robinson, Sr.
[Francis A. Ellis
Harry M. Robinson, Jr.
Dermatologists \ A. Albert Shapiro
I Israel Zeligman
[Eugene S. Bereston
Psychiatrist-in-Chief Jacob E. Finesinger
[H. Whitman Newell
Psychiatrists -JKathryn L. Schultz
[Ephriam T. Lisansky
Pediatrician-in-Chief J. Edmund Bradley
C. Loring Joslin
Gordon E. Gibbs
A. H. Finkelstein
William M. Seabold
Patkologist-in-Chief Hugh R. Spencer
f Dexter L. Reimann
'[John A. Wagner
Surgeon-in-Chief Charles Redd Edwards
George H. Yeager
Otto C. Brantigan
Charles A. Reifschnehjer
Harry C. Hull
Neurological Surgeon-in-Chief Charles Bagley, Jr.
0 [Richard G. Coblentz
Surgeons '
Pediatricians .
Pathologists .
Surgeons .
Neurological
(James G. Arnold, Jr.
24
UNIVERSITY OF MARYLAND
Orthopedic Surgeons .
Dentists .
UNIVERSITY HOSPITAL STAFF— Cont'd.
Laryngologist-in-Chief Edward A. Looper
Laryngologists ( Thomas R. O'Rourk
[Frederick T. Kyper
Proctolologist-in-Chief Monte Edwards
Proctologist Thurston R. Adams
Orthopedic Surgeon-in-Chief Allen F. Voshell
Moses Gellman
Henry F. Ullrich
Melton J. Wilder
James P. Miller
Urologist-in-Chief W. Houston Toulson
I LYLE J. MlLLAN
Urologists | Howard B. Mays
[John D. Young
Dental Surgeon-in-Chief Brice M. Dorsey
Myron S. Aisenberg
Joseph C. Blddix
Harold Golton
Joseph P. Cappuccio
Edward C. Dobbs
Grayson W. Gaver
Hugh T. Hicks
Conrad L. Inman
Ernest B. Nuttall
Kenneth V. Randolph
Wilbur 0. Ramsey
Lewis C. Toomey
Roentgenologist-in-Chief Walter L. Kilby
„ , . M { Charles N. Davidson
Roentgenologists L-. T „
{ Donald J. Barnett
[John M. Dennis
Bronchoscopist-in-Chief Edward A. Looper
Thomas R. O'Rourk
Frederick T. Kyper
John H. Hirschfeld
Richard J. Cross6
Ross C. Brooks
John M. Rehberger
Thomas D. Michael
Otologist-in-Chief Thomas R. O'Rourk
Anesthesiologist-in-Chief Alfred T. Nelson
Anesthesiologist Frank J. Brady
/ Louis H. Douglass
\D. Frank Kaltretder
J. Morris Reese
ISADORE A. SlEGEL
' Ijohn E. Savage
Hugh B. McNally
Ophthalmologist-in-Chief F. Edwin Knowles, Jr.
Ophthalmologist Paul N. Friedman
Bronchoscopists .
Obstetricians-in-Chief .
Obstetricians .
Gynecologists .
SCHOOL OF MEDICINE 25
UNIVERSITY HOSPITAL STAFF— Cont'd.
(jOHN C. OZAZEWSKI
Assistant Ophthalmologists I J. E. Brumback
[Ruby A. Smith
Gynecologist-in-Chief J. Mason Hundley, Jr.
[Leo Brady
I Beverley C. Compton
I William K. Diehl
Everett S. Diggs
Ernest I. Cornbrooks, Jr.
John C. Dumler
Oncologist-in-Chief J. Mason Hundley, Jr.
UNIVERSITY HOSPITAL RESIDENT AND INTERN STAFF
July 1, 1951 to June 30, 1952
Jose A. Alvarez, B.S., M.D., Co-Resident in Neurosurgery, Baltimore City Hospital,
July 1, 1951 to January 31, 1952; Resident in Neurological Surgery University Hos-
pital, Feb. 1, 1952 to June 30, 1952.
Charles Bagley, III, B.S., M.D., Assistant Resident in Surgery
Claude F. Bailey, A.B., M.D., Assistant Resident in Gynecology
Thomas G. Barnes, A.B., M.D., Co-Resident in Surgery
James M. Bisanar, M.D., Assistant Resident in Pediatrics
Francis J. Borges, B.S., M.D., Assistant Resident in Medicine
Joseph B. Bronushas, B.S., M.D., Assistant Resident in Medicine
James S. Browne, M.D., Assistant Resident in Neurosurgery
Donald B. Campbell, M.D., Assistant Resident in Obstetrics
Garrett E. Deane, M.D., Resident in Pediatrics
Victor H. Esch, M.D., Assistant Resident in Surgery
John E. Evans, B.S., M.D., Assistant Resident in Surgery
Joseph E. Furman, B.S., M.D., Assistant Resident in Pediatrics
Joseph B. Ganey, A.B., M.D., Co-Resident in Surgery
Richard A. Gilbert, M.D., Resident in Gynecology
Martin K. Gorten, A.B., M.D., Assistant Resident in Pediatrics
Angelina Guddo, A.B., M.D., Resident in Ophthalmology
John R. Hankins, B.A., M.D., Assistant Resident in Surgery
Robert M. Hxdey, Jr., M.D. Assistant Resident in Pediatrics
John A. Hightower, M.D., Resident in Medicine
Erwin R. Jennings, A.B., M.D., Assistant Resident in Surgery
Douglas O. Kern, M.D., Assistant Resident in Gynecology
August Klel, Jr., M.D., Assistant Resident in Neurosurgery
Eugene R. McNinch, M.D., Fellow in Roentgenology
James R. McNinch, Jr., A.B., M.D., Assistant Resident in Surgery
Arlie R. Mansberger, Jr., M.D., Assistant Resident in Surgery
Mary E. Matthews, B.S., M.S., M.D., Assistant Resident in Pediatrics
Thomas D. Michael, M.D., Assistant Resident in Otolaryngology
John W. Newman, M.D., Assistant Resident in Obstetrics
S. Malone Parham, A.B., M.D., Resident in Obstetrics
Sim Penton, M.D., Resident in Thoracic Surgery
Carol G. Pryor, A.B., M.D., Assistant Resident in Gynecology
Benson C. Schwartz, M.D., Assistant Resident in Obstetrics, assigned to Gynecology.
26
UNIVERSITY OF MARYLAND
George VV. Smith, B.S., M.D., Co-Resident in Neurosurgery, University Hospital, July 1,
1951 to January 31, 1952; Resident in Neurological Surgery Mercy Hospital, Feb.
1, 1952 to June 30, 1952.
Edward P. Smith, Jr., B.S., M.D., Assistant Resident in Surgery
Jose G. Valderas, M.D., Assistant Resident in Gynecology, assigned to Obstetrics
Leslie A. Walker, Jr., M.D., Assistant Resident in Gynecology
John P. White, III, M.D., Assistant Resident in Surgery
Richard A. Young, A.B., M.D., Assistant Resident in Pediatrics
Henry F. Zangara, B.S., M.D., Resident in Roentgenology1
ROTATING INTERNS
John W. Bossard, B.A., M.D.
George M. Dunn, Jr., M.D.
Joseph C. Fitzgerald, B.A., M.D.
Henry E. Langenfelder, B.A., M.D.
John S. Metcalf, Jr., M.D.
Robert A. Moore, Jr., A.B., M.D.
Robert S. Mosser, B.S., M.D.
Arthur Schmale, M.D.
Henry D. Perry, Jr., A.B., M.D.
Henry G. Reeves, Jr., B.S., M.D.
Eugene B. Rex, M.D.
Aubrey D. Richardson, B.S., M.D.
Roger D. Scott, M.D.
R. Kennedy Skipton, B.S., M.D.
Charles P. Watson, Jr., A.B., M.D.
EXTERN
.... Department of Medicine
UNIVERSITY HOSPITAL OUTPATIENT DEPARTMENT STAFF
Kurt H. Nork Director
Chief of Medical Clinic Maurice C. Pincoffs
Assistant Chief, Medical Clinic Joseph C. Furnari
T. Nelson Carey
Consultants.
Physicians .
L. A. M. Krause
William K. Waller
Walter Karfgin
Louis V. Blum
Kurt Levy
Alvin Hartz
Joseph E. Muse, Jr.
James R. Karns
Morris Fine
Jonas Cohen
John B. DeHoff
! Robert E. Bauer
Charles H. Williams
Stephen Van Lill, III
Charles E. Shaw
Joseph G. Bird
Marvin Goldstein
Donald Mintzer
Fred Agee
Marvin Davis
Herbert Levicus
Lauriston Keown
1 Until October 31, 1951. Fellow beginning November 1, 1951.
SCHOOL OF MEDICINE
27
UNIVERSITY HOSPITAL OUTPATIENT DEPARTMENT— cont'd.
Assistant Gastro- Enter olo gist .
Assistant Neurologists.
Assistant Cardiologists .
Chief of Gastro-Enterology Clinic Francis G. Dickey
fz. Vance Hooper
' \ Albert J. Shochat
Chief of Neurology Clinic Leon Freedom
(William L. Fearing
\ Harry A. Teitelbaum
Chief of Chest Clinic Meyer W. Jacobson
Assistant, Diseases of the Lungs Manuel Levin
Chief of Diabetic Clinic Samuel T. R. Revell, Jr.
(Charles E. Shaw
Assistants j Joseph G. Bird
[ Perry O. Futterman
Chief of Cardiovascular Clinic C. Edward Leach
Wilfred H. Townshend
Rollin C. Hudson
Sidney Scherlis
Stephen J. Van Lill, III
Fred B. Agee, Jr.
James J. Nolan
Chief of Allergy Clinic Howard M. Bubert
Assistant Chiefs of Allergy Clinic {
[Jerome Sherman
Assistant Allergists /Edward S. Kallins
[Raymond M. Lauer
Allergy Clinic Technician Anna Sutch
Chief of Endocrinology Clinic Conrad B. Acton
Director of Dermatology and Syphilis Clinic Harry M. Robinson, Sr.
Chief of Dermatology and Syphilis Clinic Harry M. Robinson, Jr.
Francis A. Ellis
Israel Zeligman
A. Albert Shapiro
R. C. V. Robinson
Eugene S. Bereston
William R. Bundick
Dermatologists and Sy philologists .
Assistant Dermatologists and Syphilologists .
Benjamin Highstein
Lucile Caldwell
V. Harwood Link
Morris M. Cohen
Mark B. Hollander
Lee R. Lerman
Director of Psychiatric Clinic H. Whitman Newell
28
UNIVERSITY OF MARYLAND
UNIVERSITY HOSPITAL OUTPATIENT DEPARTMENT— Cont'd.
Kathryn L. Schultz
Hans W. Loewald
Ephriam Lisansky
isadore tuerk
Rudolph Marburg
Sam Novey
G. S. Ingalls
Leon Ferber
Gertrude Gross
Enoch Gallaway, III
William N. Fitzpatrick
Marion Mathews
Marvin Jaffe
Virginia Suttonfield
A ssistant Psychiatrists .
Chief Roentgenologist.
Roentgenologists
Director, Pediatric Clinic.
Chief of Pediatric Clinic . .
A ssistant Pediatricians .
Director, Pediatric Cardiac Clinic
Assistant Director, Pediatric Cardiac Clinic.
Assistant Pediatrician, Cardiac Clinic
Director, Pediatric Seizure Clinic .
Chief of Surgical Clinic
Assistant Surgeons.
. Walter L. Kilby
f John M. Dennis
.{ Charles N. Davidson
[Donald J. Barnett
. A. H. Finkelstein
. Samuel S. Glick
Louis V. Blum
Arnold F. Lavenstein
Thomas E. Weeks
J. Carlton Wich
Howard Goodman
Melvtn N. Borden
Lester Caplan
Ruth B. Baldwin
Edward Fields
Latimer Young
C. R. Gonzales
Sidney Scherlis
Gibson J. Wells
Mary Hayleck
Ruth B. Baldwin
Robert C. Sheppard
Samuel E. Proctor
William B. Settle
Karl F. Mech
James N. Cianos
Richard M. Garrett
William D. Lynn
David R. Will
Chief of Plastic Surgery Edward A. Kitlowski
SCHOOL OF MEDICINE
29
UNIVERSITY HOSPITAL OUTPATIENT DEPARTMENT— Cont'd.
Chief of Orthopedic Surgery Clinic Allen Fiske Voshell
Moses Gellman
Henry F. Ullrich
Milton J. Wilder
James P. Miller
Robert C. Abrams
Everett D. Jones
John J. Tansey
John L. Wooton
W. Houston Toulson
Assistant Orthopedic Surgeons.
Chief of Urology Clinic .
Assistant Urologists.
Chief of Otolaryngology Clinic.
Otolaryngologists
Assistant Proctologists .
John F. Hogan
Lyle J. Millan
Morris A. Fine
Howard B. Mays
John D. Young
Martin A. Robbins
Benjamin S. Rich
f Samuel L. Fox
I Albert Stelner
. { Richard J. Cross6
| John M. Rehberger
(Thomas D. Michael
Chief of Proctology Clinic Monte Edwards
(Thurston R. Adams
Donald B. Hebb
) William J. Supik
[Raymond Cunningham
Chief of Gynecology Clinic J. Mason Hundley, Jr.
Assistant Chief of Gynecology Clinic Beverley C. Compton
William K. Diehl
Everett S. Diggs
Ernest I. Cornbrooks, Jr.
W. Allen Deckert
Helen I. Maginnis
Charles B. Marek
Theodore Kardash
John C. Dumler
J. Mason Hundley, Jr.
Beverley C. Compton
William K. Dlehl
Ernest I. Cornbrooks, Jr.
Everett S. Diggs
Chief of Dental Clinic Brice M. Dorsey
A ssistant Chief of Dental Clinic Lewis C. Toomey
Assistant Gynecologists.
Female Cystoscopists .
30
UNIVERSITY OF MARYLAND
Assistant Obstetricians .
Assistants in Gynecological Division.
UNIVERSITY HOSPITAL OUTPATIENT DEPARTMENT-CWU
{ Jose Medina
_ . I Marshall I. Kader
Assistant Dentists ,. _ T
Algert P. Lazauskas
[Edmond G. Vanden Bosche
Chief of Obstetrical Clinic J. Huff Morrison
Assistant Chief of Obstetrical Clinic Margaret B. Ballard
J. K. B. E. Seegar
Charles H. Doeller, Jr.
George H. Davis
Theodore Kardash
Harry McB. Beck
William A. Dodd
Irvin P. Klemkowski
Clarence W. Martin
Vernon C. Kelly
Harry Cohen
Chief of Oncology Clinic, Gynecological Division . J. Mason Hundley, Jr.
Beverley C. Compton
William K. Diehl
Ernest I. Cornbrooks, Jr.
Everett S. Diggs
John C. Dumler
Arthur G. Siwinski
E. Eugene Covington
{ J. DUER MOORES
Edwin H. Stewart, Jr.
Louis E. Goodman
Chief of Vascular Clinic George H. Yeager
Assistant Chief of Vascular Clinic Raymond Cunningham
Medical Consultant — Vascular Clinic Lewis P. Gundry
Chief of Ophthalmology Clinic F. Edwin Knowles, Jr.
Paul N. Friedman
Ruby A. Smith
Assistant Ophthalmologists < _ "j; "
J. E. Brumback, Jr.
Richard J. Cross6
John C. Ozazewski
Professor of Speech Ray Ehrensberger, Ph.D.
Associate Professor of Speech, University of
Maryland at College Park Merle Ansberry, Ph.D.
OUT-PATIENT REPORT
JANUARY 1, 1950 TO JANUARY 1, 1951
Departments New Cases Old Cases Total
Allergy 190 4,973 5,163
Arthritis 55 247 302
Cardiology 195 1, 150 1,345
A ssistanls in Surgical Division .
SCHOOL OF MEDICINE 31
Departments New Case
Cystoscopy (Gynecological) 94
Cystoscopy (Genito-Urinary) 77
Dermatology 5, 401
Department "S" 374
Diabetic 99
Ear, Nose and Throat 1,267
Endocrine 41
Eye 1,428
Gastro-intestinal 197
Genito-urinary 937
Gynecology 2,077
Hematology 17
Medical 2,609
Neurology 129
Neuro-surgery 211
Obstetrics 2,012
Occupational Therapy 82
Oncology 320
Oral Surgery 312
Orthopedics 1 , 478
Pediatrics 2, 349
Pediatric Cardiology 21
Pediatric Chest 6
Pediatric Seizure 77
Physiotherapy 76
Plastic Surgery 32
Proctology 207
Psychiatry 315
Surgery 3, 301
Tuberculosis 248
Vascular 157
Total : 26,391 84,781 111,172
MEDICAL CARE CLINIC
UNIVERSITY HOSPITAL
Director Henry W. D. Holljes
Assistant Director Martha Curtis
The Medical Care Clinic of the University of Maryland is the result of a study
by the Medical and Chirurgical Faculty of Maryland in cooperation with the
State Planning Commission. The present Clinic, located on the third floor of
the Dispensary Building, is the first of its kind in this country. Public assistance
clients are referred to the Clinic by the Baltimore City Health Department and
are scheduled for an initial physical examination by physicians affiliated with the
Old Cases
Total
546
640
50
127
8,744
14,145
2,365
2,739
1,910
2,009
2,010
3,277
280
321
3,320
4,748
719
916
1,914
2,851
5,195
7,272
535
552
6,236
8,845
384
513
415
626
17,082
19,094
1,058
1,140
1,707
2,027
556
868
3,210
4,688
8,097
10,446
213
234
416
422
236
313
484
560
30
62
339
546
1,589
1,904
6,926
10,227
975
1,223
870
1,027
32 UNIVERSITY OF MARYLAND
University of Maryland. A family physician is chosen by the patient from a list
available at the Clinic. Copies of the individual's medical history and examina-
tions are sent to the physician selected, who then becomes responsible for the
medical care of the patient.
The Medical Care Program is, in this way, an entirely new approach to the
problem of the indigent patient. For the first time, he becomes the responsibility
of a private physician. This places the practice of medicine to the indigent on a
par with the practice of private medicine.
After the initial examination, the Clinic functions as a diagnostic center to
serve the needs of the neighborhood practitioner. Consultants working in the
Medical Care Clinic are available and at present represent Medicine, Surgery,
Gynecology and Otolaryngology. Others will be added as required.
The Clinic functions between 8:30 and 4:30 daily. Registrations and referrals
are conducted in the morning. Clinical examinations and consultations are held
during the afternoon. Approximately eighty neighborhood physicians have
agreed to work with the Medical Care Program. Twenty-five members of the
Out-patient Department and University Hospital Staff will conduct examinations
in the Clinic.
The Faculty Committee on Post Graduate Education has also undertaken plans
to provide instruction to all affiliated physicians.
4,606 public assistance clients have been assigned to this Clinic.
MERCY HOSPITAL
BOARD OF GOVERNORS
Walter D. Wise, Chairman
Mother M. Bernadette Henry F. Bongardt
Sister M. Veronica H. Raymond Peters
Sister M. Carmel Maurice C. Pincoffs
Sister M. Ellen Marie Waitman F. Zinn
Sister M. Frances Louise Thomas K. Galvin
Sister M. Damian | - , Edward P. Smith
Sister M. Thomas Elliott H. Hutchins
Sister M. Brendan Simon Brager
ADVISORY BOARD OF MERCY HOSPITAL
Most Reverend Lawrence J. Sheehan August B. Haneke
Henry C. Evans Samuel H. Hoffberger
Thomas B. Butler James W. McElroy
H. C. Byrd Allen W. Morton
Charles C. Conlon S. Page Nelson
Clarence E. Elderkin Thomas W. Pangborn
Richard A. Froehlinger William F. Schmick
William L. Galvin
SCHOOL OF MEDICINE
33
MERCY HOSPITAL STAFF
Surgeon-in-Chitf .
Surgeons
Neurological Surgeon-in-Chief .
Neurological Surgeons
Associate Surgeons
Assistant Surgeons .
Thoracic Surgeon-in-Chief .
Plastic Surgeons
Ophthalmologist-in-Chief . .
Associate Ophthalmologist .
Associate Ophthalmologists and Otologists
Walter D. Wise
f Elliott H. Hutchins
D. J. Pessagno
F. L. Jennings
R. W. Locher
Thomas R. Chambers
William F. Rienhoff
Henry F. Bongardt
Charles Bagley, Jr.
Richard B. Coblentz
James D. Arnold, Jr.
{ Frank J. Otenasek
| John W. Chambers
[Raymond K. Thompson
I. O. Rjdgely
James W. Nelson
Howard B. McElwain
Simon H. Brager
John A. O'Connor
Charles W. Maxson
I. Rddgeway Trimble
Raymond F. Helfrich
Julius Goodman
S. Demarco, Jr.
T. J. Touhey
William N. McFaul, Jr.
Meyer H. Zuravtn
Howard L. Zupnhc
Daniel R. Robinson
Joseph V. Jerardi
Wm. C. Dunnigan
Harold H. Burns
William L. Garlick
John F. Schaeffer
F. Ford Loker
Patrick C. Phelan, Jr.
Michael L. DeVincentis
Harold P. \Beehl
William L. Garlick
fEDWARD A. KlTLOWSKI
\ Clarence P. Scarborough
F. Edwin Knowles, Jr.
Joseph V. Jeppi
(M. Raskin
Joseph I. Kemler
F. A. Pacienza
34 UNIVERSITY OF MARYLAND
MERCY HOSPITAL STAFF— Cont'd.
„ ... D, . , . . ,, ... (W. Raymond McKenzie
Consulting Rhinologists and Laryngologists < _ _. ,_
6 6 ^66 [George W. Mitchell
Rhinologist and Laryngologist -in-Chief Waitman F. Zinn
Fayne A. Kayser
Benjamin S. Rich
Associate Rhinolo gists and Laryngologists • Theodore A. Schwartz
Benjamin H. Isaacs
Arthur Ward
Assistant Rhinologist and Laryngologist Joseph V. Jeppi
Bronchoscopist-in-Chief Waitman F. Zinn
Associate Bronchoscopist Fayne A. Kayser
. . . , „ , ... . [Theodore A. Schwartz
Assistant Bronchoscopists < _ _ _
[Robert Z. Berry
Orthopaedic Surgeon-in-Chief H. L. Rogers
Associate Orthopaedic Surgeon Henry F. Ullrich
(I. H. Maseritz
Assistant Orthopaedic Surgeons \ ~.' ' _
| Isaac Gutman
[Everett D. Jones
Proctologist-in-Chief SrMON P. Brager
Proctologist William J. Supic
Urologist-ni-Ckief Kenneth D. Legge
Leon K. Fargo
Francis W. Gillis
J. S. Haines
John D. Young, Jr.
Dermatologist-in-Chief Francis A. Ellis
(Eugene S. Bereston
R. C. V. Robinson
William R. Bundick
Dentist J. D. Fusco
Consulting Dentist Conrad L. Inman
Consulting Physician Maurice C. Pincoffs
Consultant, Diseases of the Chest H. Vernon Langeluttig
Physician-in-Chief H. Raymond Peters
Harvey G. Beck
Thomas P. Sprunt
George McLean
J. Sheldon Eastland
Louis A. M. Krause
Thomas C. Wolff
T. Nelson Carey
Sol Smith
Associate Urologists.
Physicians .
SCHOOL OF MEDICINE
35
MERCY HOSPITAL STAFF— Cont'd.
Associate Physicians.
Assistant Physicians.
Gastro-Enterologist
Associate Gastro-Enterologist .
Consulting Pediatrician
Pediatrician-in-Ckief
Associate Pediatrician
Assistant Pediatricians.
Associate Neurologists and Psychiatrists.
Anesthesiologist
Consulting Obstetrician
Obstetrician-in-Chief
Obstetricians.
Hubert C. Knapp
Bartus T. Baggott
Wetherbee Fort
{ Hugh J. Welch
S. Edwin Muller
Frederick J. Vollmer
William H. Kammer
S. A. TUMMINELLO
J. Howard Burns
Earl L. Chambers
K. W. GOLLEY
John R. Davis, Jr.
< J. Emmett Queen
John C. Osborne
Arthur Karfgln
Henry J. Marriott
James J. Nolan
Maurice Feldman, Jr.
Maurice Feldman
Phild? D. Flynn
Edgar B. Frledenwald
Frederick B. Smith
G. Bowers Mansdorfer
Jerome Fineman
0. Walter Spurrier
Israel P. Meranski
Edward L. Frey, Jr.
.' Earl Weeks
A. M. Bacon, Jr.6
Donald D. Cooper
Joseph M. Cordi
J. Carlton Wich
I Harry Goldsmith
Philip F. Lerner
George G. Merrill
| Edward L. Suarez-Murias
[Frederick S. Wolf6
James Russo
Edward P. Smith
John J. Erwin
[Thomas K. Galvin
J Frank K. Morris
] Ernest S. Edlow
[Hugh B. McNally
6 In Military Service.
36
UNIVERSITY OF MARYLAND
A ssociate Obstetricians .
MERCY HOSPITAL STAFF— Cont'd.
f William C. Duffy
Assistant Obstetricians .
Gynecologist-in-Chief . .
Gynecologists
Associate Gynecologists
Assistant Gynecologists.
Pathologist-in-Chief . .
Pathologist
Clinical Pathologist . .
Clinical Hematologist .
Clinical Biochemist. . .
Technicians .
Radiologist
Technicians (X-ray).
1 Charles H. Doeller, Jr.
William A. Dodd
Harry McB. Beck
Joseph C. Sheehan
Robert B. Tunney
J. Howard Burns
Harry F. Kane
William J. Rysanek, Jr.
Thomas K. Galvin
(Edward P. Smith
John J. Erwin
Frank K. Morris
[George A. Strauss, Jr.
I Ernest S. Edlow
\ Charles H. Doeller, Jr.
William A. Dodd
Harry McB. Beck
William C. Duffy
Gerald A. Galvin
Joseph C. Sheehan
Robert B. Tunney
Harry F. Kane
William J. Rysanek, Jr.
John F. Ullsperger
Walter C. Merkel
Hugh R. Spencer
H. T. COLLENBERG
H. Raymond Peters
Charles E. Brambel
Sister Paula Marie
Eleanor Behr
Ellzabeth Johnson
Carmela E. Minnick
Constance Chapman
Rita Berry
Jeanne Merritt
Florese Samorodin
Doris Stang
Mary Meyer
^Anne Murdock
Edward R. Dana
f Sister M. Kevin
I Mary Gorman
{ Henrietta McCaffrey
| Frances Muth
[Shirley Akers
SCHOOL OF MEDICINE
37
MERCY HOSPITAL RESIDENT AND INTERN STAFF
JULY 1, 1951— JUNE 30, 1952
RESIDENT STAFF
Karl A. Dillinger, B.S., M.D.
Clyde D. Thomas, Jr., M.D.
Margaret L. Sherrard, B.A., M.D.
Leonard G. Hamberry, A.B., M.D.
William B. Rever, Jr., M.D.
Sim Penton, M.D.
Pomeroy Nichols, Jr., M.D.
George W. Smith, M.D.
John A. Ferris, B.S., M.D.
Arthur R. Fleming, B.S., M.D.
Howard F. Raskin, B.A., M.D.
Charles R. Ireland, M.D.
Frank T. Kasik, Jr., B.S., M.D.
Frederick J. Heldrich, Jr., B.A., M.D.
Resident Surgeon
Associate Resident Surgeon
Senior Assistant Resident Surgeon
Junior Assistant Resident Surgeon
Junior Assistant Resident Surgeon
Resident in Thoracic Surgery*
Junior Resident in Neurosurgery {July 1, 1951
— January 31, 1952)
Senior Resident in Neurosurgery {February 1,
1952— June 30, 1952)
Resident Gynecologist
Resident Obstetrician
Resident Physician
Assistant Resident Physician
Assistant Resident Physician
Resident Pediatrician
INTERNS
John R. Buell, Jr., M.D. William H. H. Shea, B.S., M.D.
Raymond L. Clemmons, B.S., M.D. Leslie D. Simmons, B.S., M.D.
Howard C. Kramer, M.D. Edward N. Sd?ple, M.D.
Frank R. Perilla, B.S., M.D. John H. Stone, B.S., M.D.
Jeno Batjmann, M.D.f
MERCY HOSPITAL DISPENSARY STAFF
Dispensary Director
Director of Surgical Clinic .
Chief of Surgical Clinic . . .
Assistant Surgeons.
Sister M. Anita
Walter D. Wise
Harold H. Burns
I. Rddgeway Trimble
Howard L. Zupnik
Daniel R. Robinson
Joseph V. Jerardi
William C. Dunnigan
John F. Schaeffer
\ F. Ford Loker
Patrick C. Phelan
Arthur G. Siwinski
Melvin F. Polek
Michael L. DeVincentis
Paul R. Ziegler
Harold P. Biehl
* Resident at Mercy, City and University Hospitals.
f Term expires February 11, 1952.
38
UNIVERSITY OF MARYLAND
MERCY HOSPITAL DISPENSARY STAFF— Cont'd.
Chief of Plastic Surgery Edward A. Kitlowski
Assistant in Plastic Surgery Clarence P. Scarborough
Chief of Urology Clinic Kenneth D. Legge
Francis W. Glllis
Assistant Urologists.
L. K. Fargo
John S. Haines
John D. Young, Jr.
Chief of Orthopaedic Clinic Harry L. Rogers
Henry F. Ullrich
Isaac Gutman
Orthopaedic Surgeons I. H. Maseritz
Jason H. Gaskel
Everett D. Jones
Director of N euro-Surgery Clinic Charles Bagley, Jr.
(John W. Chambers
Frank J. Otenasek
Raymond K. Thompson
Director of Medical Clinic H. Raymond Peters
Sol Smith
Chiefs of Medical Clinic .
S. Edwin Muller
Frederick J. Vollmer
William H. Kammer
John R. Davis
J. Emmett Queen
Charles F. O'Donnell
Assistant Physicians \ Arthur Karfgin
John C. Osborne
Maurice Feldman, Jr.
James J. Nolan
Milton C. Linthicum
Burton Lock
Chief of Allergy Clinic S. Edwin Muller
Chief of Cardiovascular Clinic Thomas C. Wolff
JLeon Ashman
'\ Henry J. Marriott
Chief of Metabolism Clinic J. Sheldon Eastland
Assistant in Metabolism Clinic J. Emmett Queen
Gastro-Enterologist Maurice Feldman, Sr.
Associate Gastro-Enterologist Philip D. Flynn
Director of Pediatric Clinic Fred B. Smith
Chief of Pediatric Clinic G. Bowers Mansdorfer
Assistant Cardiologists.
SCHOOL OF MEDICINE
39
MERCY HOSPITAL DISPENSARY STAFF— Cont'd.
Israel T. Meranski
O. Walter Spurrier
Pediatricians { Edward L. Frey, Jr.
Earl Weeks
Joseph Cordi
Director of Neurologic and Psychiatric Clinics Phild? F. Lerner
Associate Neurologist and Psychiatrist George G. Merrill
(Edward L. Suarez-Murias
\ Frank J. Ayd, Jr.
Director of Dermatology Clinic Francis A. Ellis
1 Eugene S. Bereston
R. C. V. Robinson
William R. Bundick
Assistant Neurologist and Psychiatrists .
Oncologist
Director of Gynecology Clinic .
Chief of the Gynecology Clinic .
Assistant Gynecologists .
James W. Nelson
Thomas K. Galvin
. Frank K. Morris
Edward P. Smith
J. J. Erwin
Ernest S. Edlow
Charles H. Doeller, Jr.
William A. Dodd
Harry McB. Beck
William C. Duffy
Joseph C. Sheehan
Robert B. Tunney
Gerald A. Galvin
John M. Palese
John F. Ullsperger
Harry F. Kane
John J. Erwin
Harry F. Kane
William A. Dodd
Harry McB. Beck
Joseph C. Sheehan
Robert B. Tunney
William J. Rysanek, Jr.
Anthony DiPaula
Esophagoscopist Waitman F. Zinn
Associate Esophagoscopist Fayne A. Kayser
(Waitman F. Zinn
| Theodore A. Schwartz
Rhinologists and Laryngolo gists - Benjamin H. Isaacs
Arthur Ward
Robert Z. Berry
Chief of Obstetrical Clinic .
Obstetricians .
40 UNIVERSITY OF MARYLAND
MERCY HOSPITAL DISPENSARY STAFF— Cont'd.
!M. Raskin
F. A. Pacienza
Joseph V. Jeppi
Chief of Proctology Clinic Simon H. Brager
Assistant Proctologist William T. Supik
Chief of Dental Clink J. D. Fusco
Assistant Chief, Dental Clinic Edward R. Stinebert
Consulting Dentist Conrad L. Inman
„, . j7 ,. , f Leon Hannan
Physiotherapists < . _ TT
[Alice R. Hannan
(Sister M. Scholastica6
Anna Shawbaker
Marian L. Kinney
, . f Eva Applegarth
secretaries < .T
\ Nancy Arnold
MEDICAL CARE CLINIC
Director S. Edwin Muller
Assistant Director Frances V. Loughney
The Medical Care Clinic at Mercy Hospital is one of six special clinics established
and conducted for the Baltimore City Health Department. These clinics were established
by the Medical and Chirurgical Faculty of Maryland and the State Planning Commission.
The program takes up an unmet need for the indigent.
The City Welfare Department certifies recipients of public assistance to the Health
Department. The Health Department in turn, assigns recipients to one of the medical
care clinics operated by local hospitals, namely — Johns Hopkins, Sinai, University of
Maryland, Mercy, Provident and South Baltimore. The clinic assignments are made
primarily on a geographic basis.
During the current year the Medical Care Clinic at Mercy Hospital is providing facil-
ities for three thousand clients. It provides the eligible individual an initial physical
examination, chest X-ray, bacteriological and other laboratory tests as indicated. Ar-
rangements are also made by the Clinic to have each client register with a family physi-
cian of his or her choice selected from those Baltimore physicians who have agreed to par-
ticipate in the program. The Clinic notifies the physician chosen, and sends to him a
complete written report of the physical findings.
The plan gives physicians an opportunity for contacts with the personnel and diagnostic
facilities of the participating hospitals. At the request of the client's physician, consul-
tation services of the Staff at Mercy are made available. These services include Medicine,
Surgery, Gynecology, Urology, Orthopedics, Dermatology, Neurology and other specialties,
together with clinical laboratory facilities.
The Mercy Clinic is located on the 4th floor of the College Building. It includes a
reception area, offices and examining rooms. An active personnel of Doctors, Nurses,
Medical Technician and Medical Secretary are on duty from 9 A.M. to 5 P.M.
6 On Leave.
SCHOOL OF MEDICINE 41
MERCY HOSPITAL OUT-PATIENT REPORT
JANUARY 1, 1950 TO JANUARY 1, 1951
Departments New Cases Old Cases Total
Allergy 30 164 194
Bronchoscopic 328 567 895
Cardiology 85 257 342
Dental 224 130 354
Dermatology 338 902 1,240
Diabetic 49 517 566
Gastro-intestinal 58 113 171
Genito-urmary 112 285 397
Gynecology 438 1 , 195 1,633
Medical Care 1,929 0 1,929
Medicine 617 2,781 3,398
Neurology 132 362 494
Neuro-surgery 41 65 106
Ophthalmology , 405 373 778
Orthopaedics 256 540 796
Pediatrics 627 1,733 2,360
Physiotherapy 99 1,008 1,107
Plastic Surgery 0 3 3
Postnatal 224 2 226
Prenatal 343 2,879 3,222
Proctology 71 108 179
Rhinolaryngology 589 674 1,263
Surgery 996 2,202 3,198
Surgical Follow-Up 177 474 651
Total 8,168 17,334 25,502
THE BALTIMORE CITY HOSPITALS
STAFF, 1951-1952
Parker J. McMillin, Superintendent
Surgeon-in-Chief Otto C. Brantigan, M.D.
James C. Owings, M.D.
I. Ridgeway Trimble, M.D.
„...,.„ I Amos Koontz, M.D.
VtstUng Surgeons Thurston R. Adams, M.D.
Harry C. Bowie, M.D.
Donald B. Hebb, M.D.
Visiting Thoracic Surgeon William L. Garlick, M.D.
Consultant in Traumatic Surgery C. A. Reifschneider, M.D.
Visiting Hand Surgeon Raymond M. Curtis, M.D.
[Charles Bagley, M.D.
Visiting Netiro-Surgeons \ Richard G. Coblentz, M.D.
(James G. Arnold, M.D.
42 UNIVERSITY OF MARYLAND
BALTIMORE CITY HOSPITAL STAFF— Cont'd.
Assistant Visiting N euro-Surgeon R. K. Thompson, M.D.
Consultant in Plastic Surgery Edward A. Kitlowski, M.D.
Visiting Plastic Surgeon Clarence P. Scarborough, M.D.
Visiting Proctologist Monte Edwards, M.D.
(W. Houston Toulson, M.D.
Hugh Jewitt, M.D.
Howard B. Mays, M.D.
Assistant Visiting Urologist John D. Young, M.D.
Consulting Gynecologist J. Mason Hundley, Jr., M.D.
Visiting Gynecologist Beverly Compton, M.D.
Visiting Proctologist Monte Edwards, M.D.
TErNEST I. CORNBROOKS, M.D.
Assistant Visiting Gynecologists i William K. Diehl, M.D.
(Everett S. Diggs, M.D.
it- :• ^ ,1 . j- o /Allen F. Voshell, M.D.
v isihng Orthopedic Surgeons < , .. T ,TT ' r _
6 r 6 [Milton J. Wilder, M.D.
Assistant Visiting Orthopedic Surgeons <F r>T ' MT)
TT. . . r ... f John Bordley, M.D.
Vntmg Laryngologtsts j^ T ^^ M D
. .,,,*■:■ r 7 • i \ John H. Hirschfeld, M.D.
Assistant Visiting Laryngologtsts < . ,_T m-r^
b J b b [Alfred T. Lieberman, M.D.
Visiting Ophthalmologist Charles E. Illff, Jr., M.D.
Visiting Oncologist Arthur G. Siwinski, M.D.
f Alfred T. Nelson, M.D.
Visiting Anesthesiologists { Theodore Stacy, M.D.
[Leonard Abramovitz, M.D.
Consultant in Peripheral Vascular Diseases George H. Yeager, M.D.
Chief Pathologist C. Gardner Warner, M.D.
Visiting Neuropathologist John A. Wagner, M.D.
Consultant in Psychiatry Esther L. Richards, M.D.
Chief Radiologist John DeCarlo, Jr., M.D.
Chief Pediatrician Harold E. Harrison, M.D.
Assistant Chief Pediatrician Douglas E. Johnstone, M.D.
.,..,. „ ,. . . f Milton Markowitz, M.D.
Visitme Pediatricians <_ _, ,,-^
[Laurence Finberg, M.D.
Chief Hospital Physician — Tuberculosis H. Vernon Langeluttig, M.D.
Assistant Hospital Physician — Tuberculosis Edmund G. Beacham, M.D.
...... D, . . „ , , . /Alvin S. Hartz, M.D.
Visiting Physicians — Tuberculosis < T XT _T - , ^
[John H. Hirschfeld, M.D.
Chief Physician, Acting C. Holmes Boyd, M.D.
Assistant Chief Physician Howard K. Rathbun, M.D.
SCHOOL OF MEDICINE
43
BALTIMORE CITY HOSPITAL STAFF— Cont'd.
Visiting Physicians .
Assistant Visiting Physicians (USPHS).
Louis A. M. Krause, M.D.
William G. Speed, III, M.D.
Crawford N. Kirkpatrick, M.D.
Earnest Gross, M.D.
Joseph King, M.D.
John H. Miller, M.D.
Donald M. Watkins, M.D.
Milton Landowne, M.D.
Rodger K. MacDonald, M.D.
Morton D. Bogdonoff, M.D.
Harold M. Silver, M.D.
Physiologist Nathan W. Shock, PH.D.
Visiting Neurologist J. W. Magladery, M.D.
Assistant Visiting Neurologist David B. Clark, M.D.
Visiting Dermatologist, Raymond C. V. Robinson, M.D.
Visiting Laboratory Physician Juldjs Waghelstein, M.D.
Consultant in Hematology Phild? F. Wagley, M.D.
Consultant in Neurology Frank R. Ford, M.D.
Chief Dental Surgeon H. Glenn Waring, D.D.S.
[L. W. Blmestefer, D.D.S.
Assistant Visiting Dental Surgeons I Michael Varipatis, D.D.S.
[b. W. Miksinski, D.D.S.
Orthodontist R. Kent Tongue, D.D.S.
Exodontist Richard Colman, D.D.S.
Chief Obstetrician Louis H. Douglass, M.D.
Visiting Obstetrician J. Morris Reese, M.D.
D. Frank Kaltrelder, M.D.
Assistant Visiting Obstetricians.
John E. Savage, M.D.
J. William Dorman, M.D.
W. Newton Long, Jr., M.D.
George W. Anderson, M.D.
Louis C. Gareis, M.D,
THE JAMES LAWRENCE KERNAN HOSPITAL AND
INDUSTRIAL SCHOOL OF MARYLAND FOR
CRIPPLED CHILDREN
STAFF, 1951-1952
Surgeon-in-Chief and Medical Director Allen Fiske Voshell, A.B., M.D.
Consultant in Orthopaedic Surgery and Roent-
genology Albertus Cotton, A.M., M.D.
Moses Gellman, B.S., M.D.
Associate Orthopaedic Surgeons.
Harry F. Ullrich, M.D.
Winthrop M. Phelps, A.B.
Milton J. Wilder, M.D.
David L. Filtzer, M.D.
James P. Miller, M.D.
M.D.
44 UNIVERSITY OF MARYLAND
KERNAN HOSPITAL STAFF— Cont'd.
Roentgenologist Charles N. Davidson, M.D.
Plastic Surgeon Edward A. Kitlowski, A.B., M.D.
Aurist and Laryngologisi Benjamin S. Rich, A.B., M.D.
Dentist M. E. Coberth, D.D.S.
Cardiologist Helen M. Taussig, M.D.
Pedialrist Melchijah Spragins, M.D.
Consulting Surgeon Charles Reld Edwards, A.B., M.D.
Consulting Aurists and Laryngologists Edward A. Looper, M.D., D.Oph.
Consulting Neurological Surgeon Charles Bagley, Jr., M.A., M.D.
_, ... ^ , . . M ( Harry M. Robinson, Sr., M.D.
Consulting Dermatologists |Leqn Ginsburg> m d
„ ,,. „ . . . /Irving J. Spear, M.D.
ConsulHng Neurologists |R y ^^ M D
„ ,,. „,.,., [Benjamin Tappan, A.B., M.D.
Consulting Pedialrists < T _, _, , . '
(J. Edmund Bradley, M.D.
Consulting Dentist Harry B. McCarthy, D.D.S.
Consulting Pathologist Hugh R. Spencer, M.D.
Consulting Roentgenologist Henry J. Walton, M.D.
n -j . ^ ., . j- o {John J. Tansey, M.D.
Resident Orthopaedic Surgeons < T x ... , , _.
r b (John L. Wooten, M.D.
Superintendent Miss Maud M. Gardner, R.N.
Dispensary and Social Service Nurse Mrs. Evelyn Byrd Zapf, R.N.
(Mr. Henry Ewertz
Mrs. Anna H. Erlanger
Mrs. Georgiana Wisong
-, .. 7 „, .. . (Mrs. T. Lynn Buttrick, O.T.
Occupational Therapist s , r TT ~ ' _
t [Miss Virginia Cooper, O.T.
Instructor in Grammar School Miss Bertha Sendelback
HISTORY OF THE SCHOOL OF MEDICINE
The present School of Medicine, with the title University of Maryland School
of Medicine and College of Physicians and Surgeons, is the result of a consolida-
tion and merger of the University of Maryland School of Medicine with the
Baltimore Medical College (1913) and the College of Physicians and Surgeons of
Baltimore (1915).
Through the merger with the Baltimore Medical College, an institution of
thirty-two years' growth, the facilities of the School of Medicine were enlarged in
faculty, equipment and hospital connection.
The College of Physicians and Surgeons was incorporated in 1872, and estab-
lished on Hanover Street in a building afterward known as the MaterniU, the
first obstetrical hospital in Maryland. In 1878 union was effected with the
Washington University School of Medicine, in existence since 1827, and the college
was removed to Calvert and Saratoga Streets. Through the consolidation with
SCHOOL OF MEDICINE 45
the College of Physicians and Surgeons, medical control of the teaching beds in
the Mercy Hospital was obtained.
The School of Medicine of the University of Maryland is one of the oldest foun-
dations for medical education in America, ranking fifth in point of age among the
medical colleges of the United States. It was organized in 1807 and chartered
in 1808 under the name of the College of Medicine of Maryland, and its first
class was graduated in 1810. In 1812 the College was empowered by the Legisla-
ture to annex three other colleges or faculties: Divinity, Law, and Arts and
Sciences; and the four colleges thus united were "constituted an University by the
name and under the title of the University of Maryland."
The original building of the Medical School at the N. E. corner of Lombard and
Greene Streets was erected in 1812. It is the oldest structure in this country
from which the degree of doctor of medicine has been granted annually since its
erection. In this building were founded one of the first medical libraries and one
of the first medical school libraries in the United States.
At this Medical School dissection was made a compulsory part of the curriculum,
and independent chairs for the teaching of gynecology and pediatrics (1867), and
of ophthalmology and otology (1873), were installed for the first time in America.
This School of Medicine was one of the first to provide for adequate clinical
instruction by the erection of its own hospital in 1823. In this hospital intramural
residency for senior students was established for the first time.
The School of Medicine has been co-educational since 1918.
BUILDINGS AND FACILITIES
The original medical building at the N. E. corner of Lombard and Greene
Streets houses the office of the Dean, Room 101, the office of the Committee on
Admissions, Room 102, two lecture halls, the faculty room and office of the assist-
ant business manager.
The Administration Building, to the east of the original building, contains the
Baltimore offices of the Registrar and two lecture halls.
The laboratory building at 31 South Greene Street is occupied by the depart-
ments of Pathology, Bacteriology and Biochemistry.
The Frank C. Bressler Research Laboratory provides the departments of
Anatomy, Histology and Embryology, Pharmacology, Physiology and Clinical
Pathology with facilities for teaching and research. It also houses the research
laboratories of the clinical departments, animal quarters, a laboratory for teaching
Operative Surgery, a lecture hall and the Bressler Memorial Room.
This building was erected in 1939-1940 at 29 South Greene Street opposite the
University Hospital. It was built with funds left to the School of Medicine by
the late Frank C. Bressler, an alumnus, supplemented by a grant from the Federal
government. The structure, in the shape of an I, extends east from Greene
Street, just north of the original building.
MEDICAL LIBRARY
The Medical Library of the University of Maryland, founded in 1813 by the
purchase of the collection of Dr. John Crawford, now numbers 33,000 volumes and
46 UNIVERSITY OF MARYLAND
several thousand pamphlets and reprints. Over four hundred of the leading
medical journals, both foreign and domestic, are received regularly. The library
is housed in Davidge Hall, in close proximity to classrooms and laboratories, and
is open daily for the use of members of the faculty, the student body and the
profession generally. Libraries pertaining to particular phases of medicine are
maintained by several departments of the medical school.
The library of the Medical and Chirurgical Faculty of Maryland and the Welch
Medical Library are open to students of the medical school without charge.
Other libraries of Baltimore are the Peabody Library and the Enoch Pratt Free
Library.
DISPENSARY BUILDING
The old hospital building has been remodeled and is occupied by the Out-patient
Department. Thus the students have been provided with a splendidly appointed
group of clinics for their training in out-patient work. All departments of clinical
training are represented in this remodeled building and all changes have been
predicated on the teaching function for which this department is intended.
The office of the Medical School Physician is located in this building.
The Department of Art also occupies quarters here.
UNIVERSITY HOSPITAL
The University Hospital, which is the property of the University of Maryland,
is the oldest institution for the care of the sick in the state of Maryland. It was
opened in September 1823, under the name of the Baltimore Infirmary, and at
that time consisted of but four wards, one of which was reserved for patients with
diseases of the eye.
In 1933-1934 the new University Hospital was erected and patients were
admitted to this building in November 1934. The new hospital is situated at the
southwest corner of Redwood and Greene Streets, and is consequently opposite
the medical school buildings. The students, therefore, are in close proximity
and little time is lost in passing from the lecture halls and laboratories to the
clinical facilities of the new building.
This new building, with its modem planning, makes a particularly attractive
teaching hospital and is a very valuable addition to the clinical facilities of the
medical school.
The new hospital has a capacity of 435 beds and 65 bassinets devoted to general
medicine, surgery, obstetrics, pediatrics, and the various medical and surgical
specialties.
The teaching zone extends from the second to the eighth floor and comprises
wards for surgery, medicine, obstetrics, pediatrics, and a large clinical lecture hall.
There are approximately 270 beds available for teaching.
The space of the whole north wing of the second floor is occupied by the de-
partment of roentgenology. The east wing houses clinical pathology and special
laboratories for clinical microscopy, biochemistry, bacteriology, and an especially
well appointed laboratory for students' training. The south wing provides space
for electro-cardiographic and basal metabolism departments, with new and very
SCHOOL OF MEDICINE 47
attractive air-conditioned or oxygen therapy cubicles. The west wing contains
the departments of rhinolaryngology and bronchoscopy, industrial surgery, and
male and female cystoscopy.
The third and fourth floors each provide two medical and two surgical wards.
The fifth floor contains two wards for pediatrics, and on the sixth floor there are
two wards for obstetrics. Each ward occupies the space of one wing of the
hospital.
On the seventh floor is the general operating suite, the delivery suite, and the
central supply station. The eighth floor is essentially a students' floor and affords
a mezzanine over the operating and delivery suites, and a students' entrance to
the clinical lecture hall.
In the basement there is a very well appointed pathological department with a
large teaching autopsy room and its adjunct service of instruction of students in
pathological anatomy.
The hospital receives a large number of accident patients because of its prox-
imity to the largest manufacturing and shipping districts of the city.
The obstetrical service provides accommodation for 40 ward patients and
assures the student abundant obstetrical training. During the year ending De-
cember 31st 1950, 3217 patients were delivered and discharged. Of these, 2288
were service cases and available for teaching. Each member of the graduating
class participated in an average of 15 deliveries in addition to those he attended
at Baltimore City Hospitals as a junior student.
The dispensaries associated with the University Hospital and the Mercy Hospi-
tal are organized upon a uniform plan in order that the teaching may be the same
in each. Each dispensary has the following departments: medicine, surgery,
pediatrics, ophthalmology, otology, genito-urinary, gynecology, gastroenterology,
neurology, orthopaedics, proctology, dermatology, laryngology, rhinology, car-
diology, tuberculosis, psychiatry, oral surgery and oncology.
All students in their junior year work each day during one-third of the year
in the departments of medicine and surgery of the dispensaries. In their senior
year, all students work one hour each day in the special departments.
MERCY HOSPITAL
The Sisters of Mercy first assumed charge of the Hospital at the corner of Cal-
vert and Saratoga Streets, then owned by the Washington University, in 1874.
By the merger of 1878 the Hospital came under the control of the College of
Physicians and Surgeons, but the Sisters continued their work of ministering to the
patients.
In a very few years it became apparent that the City Hospital, as it was then
called, was much too small to accommodate the rapidly growing demands upon it.
However, it was not until 1888 that the Sisters of Mercy, with the assistance of
the Faculty of the College of Physicians and Surgeons, were able to lay the corner-
stone of the present hospital. This building was completed and occupied late in
1889. Since then the growing demands for more space have compelled the erec-
tion of additions, until now there are accommodations for 350 patients.
48 UNIVERSITY OF MARYLAND
In 1909 the name was changed from The Baltimore City Hospital to Mercy
Hospital.
The clinical material in the free wards is under the exclusive control of the
Faculty of the University of Maryland School of Medicine and College of Physi-
cians and Surgeons.
THE BALTIMORE CITY HOSPITALS
The clinical facilities of the School of Medicine have been largely increased by
the liberal decision of the Department of Public Welfare to allow the use of the
wards of these hospitals for medical education. The autopsy material also is
available for student instruction.
Members of the junior class make daily visits to these hospitals for clinical
instruction in medicine, surgery, and the specialties.
The Baltimore City Hospitals consist of the following separate divisions:
The General Hospital, 400 beds, 90 bassinets.
The Hospital for Chronic Cases, 575 beds.
The Hospital for Tuberculosis, 280 beds.
Infirmary (Home for Aged) 700 beds.
THE JAMES LAWRENCE KERNAN HOSPITAL AND INDUSTRIAL SCHOOL OF
MARYLAND FOR CRIPPLED CHILDREN
This institution is situated on an estate of 75 acres at Dickeyville. The site
is within the northwestern city limits and of easy access to the city proper.
The location is ideal for the treatment of children, in that it affords all the ad-
vantages of sunshine and country air.
A hospital unit, complete in every respect, offers all modern facilities for the
care of any orthopaedic condition in children.
The hospital is equipped with 80 beds — endowed, and city and state supported.
The orthopaedic dispensary at the University Hospital is maintained in closest
affiliation and cares for the cases discharged from the Kernan Hospital. The
physical therapy department is very well equipped with modern apparatus
and trained personnel. Occupational therapy has been fully established and
developed under trained technicians.
THE BALTIMORE EYE, EAR, AND THROAT HOSPITAL
This institution was first organized and operated in 1882 as an outgrowth of the
Baltimore Eye and Ear Dispensary, which closed on June 14, 1882. The name
then given to the new hospital was The Baltimore Eye and Ear Charity Hospital.
It was located at the address now known as 625 W. Franklin St. The out-patient
department was opened on September 18, 1882 and the hospital proper on
November 1 of the same year. In 1898 a new building afforded 24 free beds
and 8 private rooms; by 1907 the beds numbered 47; at present there are 60 beds,
29 of which are free. In 1922 the present hospital building at 1214 Eutaw Place
was secured and in 1926 the dispensary was opened. In 1928 a clinical laboratory
was installed. During 1950 the out-patient visits numbered 20,720.
SCHOOL OF MEDICINE 49
Through the kindness of the Hospital Board and Staff, our junior students
have access to the dispensary which they visit in small groups for instruction in
ophthalmology.
REQUIREMENTS FOR ADMISSION
METHOD OF MAKING APPLICATION
Requests for application forms should be filed not earlier than September '.1 5th
preceding by one year the desired date of admission. These forms may be secured
from the Committee on Admissions, School of Medicine, University of Maryland,
Baltimore 1, Maryland.
APPLICATION FOR ADMISSION TO THE FIRST YEAR
Application for admission is made by firing the required form and by having all
pertinent data sent directly to the Committee on Admissions, in accordance with
the instructions accompanying the application.
Consideration will be given applications received after December 1st provided
the class is not complete.
APPLICATION FOR ADMISSION TO ADVANCED STANDING
Students who have attended approved medical schools are eligible to file ap-
plications for admission to the second- and third-year classes only. These ap-
plicants must be prepared to meet the current first-year entrance requirements in
addition to presenting acceptable medical school credentials, and a medical school
record based on courses which are quantitatively and qualitatively equivalent to
similar courses in this school.
Application to advanced standing is made in accordance with the instructions
accompanying the application form.
Persons who already hold the degree of Doctor of Medicine will not be admit-
ted to the Medical School as a candidate for that degree from this university.
MINIMUM REQUIREMENTS FOR ADMISSION
The minimum requirements for admission to the School of Medicine are:
(a) Graduation from an approved secondary school, or the equivalent in
entrance examinations, and
(b) Three academic years of acceptable college credit, exclusive of physical edu-
cation and military sciences, earned in colleges of arts and sciences,
whose names occur in the current list of "Approved Colleges of Arts and
Sciences" as compiled by the Council on Medical Education and Hos-
pitals of the American Medical Association. The quantity and quality
of this course of study shall be equivalent to that required for recommen-
dation by the institution where the college courses are being, or have
been, pursued.
so
UNIVERSITY OF MARYLAND
(c) The following courses and credits in basic required subjects must be
completed by June of the year the applicant desires to be admitted:
Semester hours Quarter hours
General biology or zoology *(6) 8 *(9) 12
Inorganic chemistry *(6) 8 *(9) 12
Organic chemistry 6-8 9-12
General physics *(6) 8 *(9) 12
English 6 9
Modern language (German, French, Spanish) . . 6 9
* Consideration will be given applicants from the New England area where 6 semester
hours, or 9 quarter hours, is the standard credit for a science course.
(d) The total semester-hour or quarter-hour credits presented must be equiv-
alent in quantity and quality to three-fourths of the credit requirement
for graduation by the recommending institution, exclusive of courses in
physical education and military sciences.
Applicants who are unable to complete these requirements by June of the
year admission is desired, will be considered contingent on places being
available, provided all basic required courses and credits shall have been
absolved by June as indicated in (c) above.
(e) Students will not be admitted who have unabsolved conditions or failures
in college courses.
Elective courses should be selected from the following three groups,
desirable courses are shown in bold face type.
Highly
Natural Sciences
Vertebrate Embryol-
ogy
Comparative Vertebrate
Anatomy
Quantitative Analysis
Physical Chemistry
Mathematics
Social Sciences
Economics
History
Political Science
Psychology (a general
course is desirable)
Sociology, etc.
Humanities
English (an advanced
course in English
composition should
be taken, if possible)
Scientific German or
French (A reading
knowledge of either
language is desirable,
although German is
preferred)
Philosophy
Careful attention should be given to the selection of elective courses in the
natural sciences. It is suggested that the elective list given herewith be used as
a guide. The remainder of college credits should be accumulated from courses
designed to promote a broad cultural development. Thirty six hours or the
equivalent in session hours or courses in the humanities are recommended.
Students should avoid taking courses in college which are included in the medical
curriculum, for example histology, human anatomy, bacteriology, physiology,
neurology and physiological chemistry.
It is not intended that these suggestions be interpreted as restrictions upon
SCHOOL OF MEDICINE 51
the education of students who exhibit an aptitude for the natural sciences or as
limitations upon the development of students who plan to follow research work in
the field of medicine.
In accepting candidates for admission, preference will be given to those appli-
cants who have acceptable scholastic records in secondary school and college,
satisfactory scores in the Medical College Admission Test, given in May each
year, favorable letters of recommendation from their premedical committees, or
from one instructor in each of the departments of biology, chemistry, and
physics, and who in other respects give promise of becoming successful students
and physicians of high standing.
Those candidates for admission who are permanently accepted will receive
a certificate of matriculation from the office of the Dean.
COMBINED COURSE IN ARTS AND SCIENCES AND MEDICINE
A combined seven years' curriculum leading to the degrees of Bachelor of
Science and Doctor of Medicine is offered by the University of Maryland. The
first three years are taken in residence in the College of Arts and Sciences at Col-
lege Park, and the last four years in the School of Medicine in Baltimore. (See
University catalogue for details of quantitative and qualitative college course
requirements.)
If a candidate for the combined degree completes the work of the first year in
the School of Medicine with an average of C or better without failures, and if he
has absolved the quantitative and qualitative college requirements set up by the
University, he is eligible to recommendation by the Dean of the School of Medicine
that the degree of Bachelor of Science be conferred.
Because the general commencement usually takes place before the School of
Medicine is prepared to release grades of the first-year class, this combined degree
of Bachelor of Science is conferred at the commencement following the candidate's
second year of residence in the School of Medicine.
STATE MEDICAL STUDENT QUALIFYING CERTIFICATES
Candidates for admission who live in or expect to practice medicine in Pennsyl-
vania, New Jersey or New York, should apply to their respective state boards of
education for medical student qualifying certificates (Pennsylvania and New
Jersey) or approval of applications for medical student qualifying certificates
(New York).
Those students who are accepted must file satisfactory State certificates in the
office of the Committee on Admissions, School of Medicine, before registration.
No exceptions will be made to this requirement.
Addresses of the State Certifying Offices
Director of Credentials Section, Pennsylvania Department of Public In-
struction, Harrisburg, Pa.
Chief of the Bureau of Credentials, New Jersey Department of Public In-
struction, Trenton, N. J.
Supervisor of Qualifying Certificates, The State Education Department,
Examinations and Inspections Division, Albany, N. Y.
52 UNIVERSITY OF MARYLAND
DEFINITION OF RESIDENCE STATUS OF STUDENTS*
Students who are minors are considered to be resident students if, at the time
of their registration, the parents* have been residents of this State for at least
one year.
Adult students are considered to be resident students if, at the time of their
registration, they have been residents of this State for at least one year, provided
such residence has not been acquired while attending any school or college in
Maryland.
The status of the residence of a student is determined at the time of his first
registration in the university and may not thereafter be changed by him unless,
in the case of a minor, his parents* move to and become legal residents of this
state by maintaining such residence for at least one full calendar year. However,
the right of the student (minor) to change from a non-resident to a resident status
must be established by him prior to registration for a semester in any academic
year.
CURRENT FEES
Matriculation fee (paid once) $10.00
Tuition fee (each year) — Residents of Maryland 450.00
Tuition fee (each year)— Non-Residents 700.00
Laboratory fee (each year) 25 .00
Student health service fee (each year) 20.00
Student activities and service fee (each year). 15 . 00
fLodging and meals fee 6. 75
Graduation fee 15 .00
Re-examination fee (each subject) 5 . 00
Transcript fee to graduates. First copy gratis, each copy thereafter . . 1 . 00
RULES FOR PAYMENT OF FEES
No fees are returnable.
Make all checks or money orders payable to the "University of Maryland".
When offering checks or money orders in payment of tuition and other fees,
students are requested to have them drawn in the exact amount of such fees.
Personal checks whose face value is in excess of the fees due will be accepted for
collection only.
Acceptance. — Payment of the matriculation fee of $10.00 and of a deposit on
tuition of $50.00 is required of accepted applicants before the expiration date
specified in the offer of acceptance. This $60.00 deposit is not returnable and
* The term "parents" includes persons who have been legally constituted the guardians
of or stand in loco parentis to such minor students.
t Junior Students will be billed for this fee, covering lodging and meals while on obstet-
rical service at Baltimore City Hospitals. Section B. on Schedule 2 will be billed for the
first semester; Section A on Schedule 2 for the second semester. This fee must be paid
by all junior students whether or not they serve during the previous summer or the
academic year.
SCHOOL OF MEDICINE 53
will be forfeited if the applicant fails to register, or it will be applied to the appli-
cant's first semester's charges on registration.
Registration. — All students, after proper certification, are required to register
at the business office, Gray Laboratory. (See calendar page 5 of this bulletin
for dates for the payments of fees, and the note regarding late registration fee.)
One-half of the tuition fee, the laboratory fee, the student health fee, the mainte-
nance and service fee and the student activities fee are payable on the date specified
for registration for the first semester.
The remainder of the tuition fee shall be paid on the date designated for the
payment of fees for the second semester. Fourth year students shall pay the
graduation fee, in addition, at this time.
PENALTY FOR NON-PAYMENT OF FEES
If semester fees are not paid in full on the specified registration dates, a penalty
of $5.00 will be added.
If a satisfactory settlement, or an agreement for settlement, is not made with
the business office within ten days after a payment is due, the student automatically
is debarred from attendance on classes and will forfeit the other privileges of the
School of Medicine.
REEXAMINATION FEE
A student who is eligible to reexaminations must pay the business office $5.00 for
each subject in which he is to be examined, and he must present the receipt to the
faculty member giving the examination before he will be permitted to take the
examination.
STUDENT ACTIVITIES AND SERVICE FEE
This fee pays for the use of clothing lockers, provides library privileges, main-
tains student loan collections, a student lounge and cafeteria. It supports a rec-
reational program for students of all classes, provides photographs for all school
purposes, including state boards. It supports the activities of the Student
Council.
STUDENT HEALTH SERVICE
James R. Karns, M.D Director, Student Health Service.
The Medical School has made provision for the systematic care of students ac-
cording to the following plan:
1. Preliminary Examination — All new students will be examined during the
first week of the semester. Notice of the date, time, and place of the examination
will be announced to the classes and on the bulletin board. The passing of this
physical examination is necessary before final acceptance of any student.
2. Medical Attention — Students in need of medical attention will be seen by
the school physician, Dr. James R. Karns, in his office at the medical school, at
9 A.M. daily, except Saturday and Sunday. In case of necessity, students will be
seen at their homes.
54 UNIVERSITY OF MARYLAND
3. Hospitalization — If it becomes necessary for any student to enter the hospital
during the school year, the school has arranged for the payment of part or all of his
hospital expenses, depending on the length of his stay and special expenses incur-
red. This applies only to students admitted through the school physician's office.
4. Physical Defects — Prospective students are advised to have any known
physical defects corrected before entering school in order to prevent loss of time
which later correction might incur.
5. Eye Examination — Each new matriculant is required to undergo an eye
examination at the hands of an oculist (Doctor of Medicine) within the three
months immediately preceding his entrance to the School of Medicine. Long
study hours bring out unsuspected eye defects which cause loss of time and ineffi-
ciency in study if not corrected before school work is under way.
6. Limitations — It is not the function of this service to treat chronic conditions
contracted by students before admission, nor to extend treatment to acute condi-
tions arising in the period between academic years, unless the school physician
recommends this service.
GENERAL RULES
The right is reserved to make changes in the curriculum, the requirements for
graduation, the fees and in any of the regulations whenever the university
authorities deem it expedient.
GRADING SYSTEM
Official grades are designated by these symbols:
mbol
Scholarship
Numerical Equivalent
A
Superior
93-100
B
Good
87- 92
C
Fair
80- 86
D
Passing
75- 79
F
Failure
Below 75
I
Incomplete
—
WF
Withdrew, failing
—
The class standing of seniors only will be released. This standing will appear
on senior grade reports sent out from the Registrar's office after graduation.
ADVANCEMENT AND GRADUATION
1. No medical student will be permitted to begin work for credit in any semester
of any year who reports for classes later than one week after classes begin, except
by permission of the Dean.
2. No student will be permitted to advance with unabsolved failures
3. An average of C or better without failures in the year most recently com-
pleted is required for advancement to junior and senior standing and for grad-
uation.
4. A student who in any one year has one failure together with grades of D
in all other subjects, will be dropped from the rolls.
SCHOOL OF MEDICINE 55
5. A student who has failures in two completed major subjects will be dropped
from the rolls.
6. All students are required to attend 85% of scheduled classes and (excluding
seniors) take spring examinations unless excused by the Dean.
7. Should a student be required to repeat any year in any course, he must pay
regular fees.
8. A student failing his final examinations for graduation at the end of the fourth
year will be required to repeat the entire course of the fourth year and take exam-
inations in such other branches as may be required, provided he is permitted to
enter the school as a candidate for graduation.
9. The general fitness of a candidate for graduation as well as the results of his
examinations will be taken into consideration by the faculty.
EQUIPMENT
10. At the beginning of the first year, all freshmen must provide themselves
with microscopes of a satisfactory type equipped with a mechanical stage and a
substage lamp. Also, each freshman must possess a complete set of dissecting
instruments.
A standard microscope of either Bausch & Lomb, Leitz, Spencer, Zeiss or any
other make, fitted with the following attachments, will meet the requirements.
Students are cautioned that odd-lot instruments may be valueless and difficult
to repair.
16 mm., lOx, 0.25 N.A. — 4.9 mm. working distance.
4 mm., 43x, 0.65 N.A. — 0.6 mm. working distance.
1.8 mm., 97x, oil immersion, 1.25 N.A.— 0.13 mm. working distance.
Oculars: lOx and 5x. Huygenian eyepieces.
Triple nose pieces with 16 mm., 4 mm., and 1.9 mm. 125 N.A. oil immersion lens.
Wide aperture stage with quick screw condenser and built on, but detachable,
ungraduated mechanical stage. Substage condenser, variable focusing type 1.25
N.A. with iris diaphragm. A rack and pinion focusing device is preferred. Mir-
ror plane on one side, concave on the other. A carrying case is recommended.
Students are cautioned with respect to the purchase of used microscopes since
some older instruments were equipped with a 4 mm. (high dry) objective whose
N.A. is marked as 0.85 N.A. This objective has such a short working distance
(0.3 mm.) that it is difficult or impossible to focus through thick cover glasses or
the standard haemocytometer cover glass without breakage. All used microscopes
are subject to inspection and approval by the Department of Microscopic Anatomy,
second floor Bressler Research Laboratory, 29 S. Greene Street. See Dr. Lutz. This
inspection is not made during August.
1 1 . Students in the second year class are required to provide stethoscopes.
12. Third- and fourth-year students are required to provide themselves with
haemocytometers, sphygmomanometers, opthalmoscopes and otoscopes.
STATE QUALIFYING CERTIFICATES
13. Candidates for admission who live in or expect to practice medicine in
Pennsylvania, New Jersey or New York must file State qualifying certificates in
56 UNIVERSITY OF MARYLAND
the office of the Committee on Admissions, School of Medicine, before registration.
No exception will be made to this rule.
EYE EXAMINATION BEFORE ADMISSION
14. Each new matriculant in each class is required to present to the Committee
on Admissions a certificate from an oculist, (a graduate in medicine) that the
matriculate's eyes have been examined and are in condition, with or without
glasses as the case may be, to endure the strain of close and intensive reading.
It is required that this examination be completed within three months prior to
registration and that the certificate be mailed to the Committee on Admissions
not later than one month before registration.
AWARDING OF COMBINED DEGREES
15. Students entering the School of Medicine on a three-year requirement basis
from colleges which usually grant a degree on the successful completion of the first
year of medicine, are restricted by the following regulations:
a — The candidate must present a certificate from his college or university that
he has absolved the quantitative and qualitative premedical requirements
for this degree.
b — The candidate must acquire an average of C or better without failures for
the work of his first year in the School of Medicine.
c — The Dean of the School of Medicine reserves the right to withhold his
recommendation that a bachelor's degree be conferred at a commencement
which occurs before the official release of first-year medical grades.
COST OF TRANSCRIPTS
16. Graduates will receive the first transcript of record without charge. Subse-
quent copies will cost one dollar each. Requests for transcripts must be filed
with the Registrar's Office, University of Maryland, Lombard and Greene
Streets, Baltimore-1, Maryland.
HOUSING
There are no housing or living accommodations on the campus of the medical
school.
PARKING
Because of lack of space on the university parking lots no parking facilities
are provided thereon for students.
LIBRARY REGULATIONS
Loan Regulations
Loan periods have been worked out according to demand for and protection of
different types of material.
Two-Week Loans: All books except those on reserve.
One-Week Loans: All journals except the latest number (which does not
circulate), and those on reserve.
SCHOOL OF MEDICINE 57
Overnight Loans: Books and journals on reserve.
(4 p.m.-12 :30 a.m.)
Special Rules for Books on Reserve:
Students whose names appear on the check-list for the Mercy Hospital section
will be granted the necessary hours to return reserve books.
Overnight books may be reserved in advance only within the week in which they
will be used. Books may be reserved on Saturday for the following Monday.
Overnight books may not be reserved two successive nights by the same person.
Advance reserves will be held until one hour before closing.
Fines
Fines are imposed not to acquire money, but to assure equal access to books
Two-Week Loans: 5 1 per day.
One-Week Loans: 5£ per day.
Overnight Loans: 15 £ for first hour; 5£ for each additional hour or fraction
thereof.
Lost Books: List price of the book. (Lost books should be reported at once).
All books must be returned, lost books replaced or paid for, and fines paid before
a student can finish the year in good standing.
In fairness to all concerned, these rules must be enforced without exception.
CERTIFICATION FOR STATE BOARD AND NATIONAL BOARD
EXAMINATIONS
No student will be certified to State Board or National Board examiners who
has unabsolved failures in subjects taken during the academic period covered
by these examinations.
WITHDRAWALS AND REFUNDS
Formal Withdrawal Procedures
Students over 21 years of age desiring to leave the School of Medicine at any
time during the academic year are required to file with the Dean a written applica-
tion for withdrawal. In addition, the student must secure an "honorable dismissal
release" form from the Dean's secretary, and return this to the Dean's office
appropriately signed by representatives of the departments listed thereon, together
with his "matriculation certificate."
If these procedures are not completed, the student will not be entitled to honor-
able dismissal nor to refund of fees.
Students under 21 years of age, must supplement the procedures previously
described with the written consent of their parents or guardians.
Academic Standing On Withdrawal
Students who voluntarily withdraw during an academic semester will be given
no credit.
Students are not permitted to resort to withdrawal in order to preclude current
or impending failures. Their standing on withdrawal will be recorded in the
registrar's office.
58 UNIVERSITY OF MARYLAND
Students who withdraw from the School of Medicine, must apply to the Com-
mittee on Admissions for readmission, unless other arrangements have been con-
summated with the Dean's written consent.
Refunds on Withdrawal
Students who are eligible to honorable dismissal will receive a refund of current
charges, after the matriculation fee has been deducted, according to the following
schedule:
Period elapsed after instruction begins. Percentage refundable
Two weeks or less 80%
Between two and three weeks 60%
Between three and four weeks 40%
Between four and five weeks 20%
After five weeks 0
PRIZES
THE FACULTY PRIZE
The Faculty will award the Faculty Gold Medal and Certificate and five Certifi-
cates of Honor to six of the first ten highest ranking candidates for graduation
who, during the four academic years, have exhibited outstanding qualifications
for the practice of medicine.
THE DR. A. BRADLEY GAITHER MEMORIAL PRIZE
A prize of $25.00 is given each year by Mrs. A. Bradley Gaither as a memorial
to the late Dr. A. Bradley Gaither, to the student in the senior class doing the best
work in genito-urinary surgery.
THE WILLIAM D. WOLFE MEMORIAL PRIZE
(Value $100.00 each)
A certificate of proficiency and a prize of $100.00 will be awarded each year
until the fund is dissipated, to the graduate selected by the Advisory Board of the
Faculty showing greatest proficiency in Dermatology.
THE DR. LEONARD M. HUMMEL MEMORIAL AWARD
A gold medal and certificate of proficiency will be awarded annually, as a
memorial to the late Dr. Leonard M. Hummel, to the graduate selected by the
Advisory Board of the Faculty who has manifested outstanding qualifications in
Internal Medicine.
SCHOLARSHIPS
All scholarships are assigned for one academic year, unless specifically rea warded
on consideration of an application.
Official application forms are obtainable at the Dean's office, where they should
be filed four months before the ensuing academic year.
THE DR. SAMUEL LEON FRANK SCHOLARSHIP
(Value $100.00)
This scholarship was established by Mrs. Bertha Rayner Frank as a memorial
to the late Dr. Samuel Leon Frank, an alumnus of this university.
SCHOOL OF MEDICINE 59
It is awarded by the Trustees of the Endowment Fund of the University each
year upon nomination by the Advisory Board of the Faculty "to a medical stu-
dent of the University of Maryland, who in the judgment of said Council, is of
good character and in need of pecuniary assistance to continue his medical
course."
This scholarship is awarded to a second, third or fourth year student who has
successfully completed one year's work in this school. No student may hold
this scholarship for more than two years.
THE CHARLES M. HITCHCOCK SCHOLARSHIPS
(Value $100.00 each)
Two scholarships were established from a bequest to the School of Medicine
by the late Charles M. Hitchcock, M.D., an alumnus of the university.
These scholarships are awarded annually by the Trustees of the Endowment
Fund of the University, upon nomination by the Advisory Board of the Faculty,
to students who have meritoriously completed the work of at least the first year
of the course in medicine, and who present to the Board satisfactory evidence of
a good moral character and of inability to continue the course without pecuniary
assistance.
THE RANDOLPH WINSLOW SCHOLARSHIP
(Value $100.00)
This scholarship was established by the late Randolph Winslow, M.D., LL.D.
It is awarded annually by the Trustees of the Endowment Fund of the Univer-
sity, upon nomination by the Advisory Board of the Faculty, to a "needy student
of the Senior, Junior, or Sophomore Class of the Medical School."
"He must have maintained an average grade of 85% in all his work up to the
time of awarding the scholarship."
"He must be a person of good character and must satisfy the Faculty Board
that he is worthy of and in need of assistance."
THE DR. LEO KARLINSKY MEMORIAL SCHOLARSHIP
(Value $125.00)
This scholarship was established by Mrs. Ray Mintz Karlinsky as a memorial
to her husband, the late Dr. Leo Karlinsky, an alumnus of the university.
It is awarded annually by the Trustees of the Endowment Fund of the Univer-
sity, upon the nomination of the Advisory Board of the Faculty, to "a needy stu-
dent of the Senior, Junior or Sophomore Class of the Medical School."
He must have maintained in all his work up to the time of awarding the scholar-
ship a satisfactory grade of scholarship.
He must be a person of good character and must satisfy the Faculty Board
that he is worthy of and in need of assistance.
THE UNIVERSITY SCHOLARSHIP
A scholarship which entitles the holder to exemption from payment of tuition
fee for the year, is awarded annually by the Advisory Board of the Faculty to a
student of the senior class in need of assistance who presents to the Board satis-
factory evidence of good character and scholarship.
60 UNIVERSITY OF MARYLAND
THE FREDERICA GEHRMANN SCHOLARSHIP
(Value $200.00)
(Not open to holders of Warfield and Cohen Scholarships)
This scholarship was established by the bequest of the late Mrs. Frederica
Gehrmann and is awarded to a third-year student who at the end of the second
year has passed the best practical examinations in physiology, pharmacology,
pathology, bacteriology, immunology, serology, surgical anatomy and neuro-
anatomy.
THE CLARENCE AND GENEVRA WARFIELD SCHOLARSHIPS
(Value $300.00 each)
There are five scholarships established by the regents from the income of the
fund bequeathed by the will of Dr. Clarence Warfield.
Terms and Conditions: These scholarships are available to students of any of
the classes of the course in medicine. Preference is given to students from the
counties of the state of Maryland which the Advisory Board of the Faculty may
from time to time determine to be most in need of medical practitioners.
Any student receiving one of these scholarships must agree, after graduation
and a year's internship, to undertake the practice of medicine, for a term of two
years, in the county to which the student is accredited, or in a county selected by
the Board. In the event that a student is not able to comply with the condition
requiring him to practice in the county to which he is accredited by the Board,
the money advanced by the regents shall be refunded by the student.
THE ISRAEL AND CECELIA E. COHEN SCHOLARSHIP
(Value $150.00)
This scholarship was established by the late Eleanor S. Cohen in memory of
her parents, Israel and Cecelia E. Cohen. Terms and conditions: This scholarship
will be available to students of any one of the classes of the course in medicine;
preference is given to students of the counties in the state of Maryland which the
Advisory Board of the Faculty may from time to time determine to be most in
need of medical practitioners. Any student receiving one of these scholarships
must, after graduation and a year's internship, agree to undertake the practice of
medicine for a term of two years in the county to which the student is accredited,
or in a county selected by the council. In the event that a student is not able to
comply with the condition requiring him to practice in the county to which he is
accredited by the Board, the money advanced by the regents shall be refunded.
THE DR. HORACE BRUCE HETRICK SCHOLARSHIP
(Value $125.00)
This scholarship was established by Dr. Horace Bruce Hetrick as a memorial
to his sons, Bruce Hayward Hetrick and Augustus Christian Hetrick. It is to
be awarded by the Advisory Board of the Faculty to a student of the senior class.
SCHOOL OF MEDICINE 61
THE HENRY ROLANDO SCHOLARSHIP
(Value approximately $250.00)
The Henry Rolando Scholarship was established by the Board of Regents of
the University of Maryland from a bequest to the Board by the late Anne H.
Rolando for the use of the Faculty of Medicine.
This scholarship will be awarded each academic year on the recommendation
of the Advisory Board of the Faculty to a "poor and deserving student."
THE READ SCHOLARSHIPS
The sum of $500.00 is now available to cover two (2) scholarships in the
amount of $250.00 each for a given academic year. Beginning in 1945, these
scholarships were made possible by a donation from the Read Drug and Chemical
Company of Baltimore, Maryland. Two students are to be selected by the Dean
of the School of Medicine in collaboration with the Scholarship and Loan Commit-
tees of the Medical School with the provision that the students selected shall be
worthy, deserving students, residents of the State of Maryland.
LOAN FUNDS
W. K. KELLOGG FUND
This loan fund was established in the academic year 1942 with money granted
by the W. K. Kellogg Foundation. The interest paid on the loans, together with
the principal of the fund as repaid, will be used to found a rotating loan fund.
Loans will be made on the basis of need, character and scholastic attainment.
FACULTY OF MEDICINE LOAN FUND
A Faculty of Medicine Loan Fund was established with money derived from
the bequest of Dr. William R. Sanderson, Class 1882, and the gift of Dr. Albert
Stein, Class 1907. Loans will be made on the basis of need, character, and
scholastic ability.
THE JAY W. EATON LOAN FUND
This fund was established by the local chapter of the Nu Sigma Nu Fraternity
in memory of Jay W. Eaton of the class of 1946.
Beginning in 1946 an interest-free loan of $100.00 will be made to some worthy
member of the senior class, on recommendation of the Scholarship Committee of
the School of Medicine. This loan is to be credited to the tuition fee of the ap-
pointed student and is to be repaid by the student within four years following his
graduation.
THE SENIOR CLASS LOAN FUND
The senior class of 1945 originated this fund which will accumulate by subscrip-
tion from among members of each senior class.
The conditions of the agreement provide that the dean of the School of Medicine
award a loan of $100.00 to a needy member of the senior class on the recommenda-
tion of a self-perpetuating committee of two members of the faculty.
Loans from this fund are to be credited to the tuition fee of the appointed
student and are to be repaid within five years from the date of graduation.
62 UNIVERSITY OF MARYLAND
THE STUDENT AID FUND FOR SENIORS
This fund was originated by the class of 1950 and is sponsored by the senior
class of each succeeding year. The purpose of the fund is to provide financial
aid for any deserving member of the senior class. All members of the senior
class are eligible to apply for a loan. Applications may be filed at the office of the
dean.
The conditions of the agreement provide that the Scholarship and Loan Com-
mittee award loans to members of the senior class on recommendation of a self-
perpetuating committee of two members of the faculty who may call on the
president of the senior class for assistance, if desired.
Loans from this fund are made on a non-interest bearing basis and are payable
within five years. A signed note is required. No co-signers are necessary.
ORGANIZATION OF THE CURRICULUM
The curriculum is organized under fifteen departments.
1. Anaesthesiology.
2. Anatomy (including Histology, Embryology, and Neuro-anatomy) .
3. Bacteriology and Immunology.
4. Biological Chemistry.
5. Gynecology.
6. Medicine (including Medical Specialties).
7. Obstetrics.
8. Ophthalmology.
9. Pathology.
10. Pediatrics.
15. Pharmacology and Materia Medica.
16. Physiology.
13. Psychiatry.
14. Roentgenology.
15. Surgery (including Surgical Specialties).
The instruction is given in four academic years of graded work.
Several courses of study extend through two years or more, but in no case are
the students of different years thrown together in the same course of teaching.
The first and second years are devoted largely to the study of the structures,
functions and chemistry of the normal body. Laboratory work occupies most of
the student's time during these two years.
Some introductory instruction in medicine and surgery is given in the second
year. The third and fourth years are almost entirely clinical.
A special feature of instruction in the school is the attempt to bring together
teacher and student in close personal relationship. In many courses of instruc-
tion the classes are divided into small groups and a large number of instructors
insures attention to the requirements of each student.
In most courses the final examination as the sole test of proficiency has dis-
appeared and the student's final grade is determined largely by partial examina-
tions, recitations and assigned work carried on throughout the course.
SCHOOL OF MEDICINE 63
ANESTHESIOLOGY
Alfred T. Nelson Professor of Anaesthesiology
and Head of the Department
Wedon Johnson Associate Professor of Anesthesiology
Isidore William Towlen Assistant Professor of Anesthesiology
Frank J. Brady Associate in Anaesthesiology
James Russo Assistant in Anaesthesiology
THIRD YEAR
Lectures are given on the general physiology and pharmacology of anesthesia,
with consideration of the special physiology and pharmacology of each anaesthetic
agent. The methods of induction and administration of anaesthesia are discussed.
The factors influencing the selection of the anaesthetic are emphasized, and the
preparation and care of the anaesthetized patient are carefully explained.
These lectures are correlated with practical demonstrations, supplemented by
lantern slides and motion pictures, at the University Hospital.
FOURTH YEAR
Each senior student is required to spend six hours per week for four weeks
observing and administering anaesthetics in the operating room.
Third year 10 hours
Fourth year 24 hours
Total 34 hours
ANATOMY
Eduard Uhlenhuth Professor of Anatomy and Head of the Department
Frank H. J. Figge Professor of Anatomy
Otto C. Brantigan Professor of Surgical Anatomy
0. G. Harne Associate Professor of Anatomy
Vernon E. Krahl Associate Professor of Anatomy
W. Wallace Walker Associate Professor of Surgical Anatomy
John F. Lutz Assistant Professor of Anatomy
William B. Settle Assistant Professor of Surgical Anatomy
Karl F. Mech Assistant Professor of Anatomy
Herbert E. Reifschnelder Associate in Surgical Anatomy
Harry C. Bowie Associate in Surgical Anatomy
Ross Z. Pierpont Associate in Surgical Anatomy
H. Patterson Mack Associate in Anatomy
Patrick C. Phelan, Jr Associate in Anatomy
V. V. Brunst Research Associate in Anatomy
Robert E. McCafferty Instructor in Anatomy
Gladys E. Wadsworth Instructor in Anatomy
George W. Smith Instructor in Anatomy
Richard M. Garrett Assistant in Surgical Anatomy
Geraldine F. Wolfe U. S. P. H. Fellow
DeWitt T. Hunter John F. B. Weaver Fellow in Anatomy
A. Gibson Packard John F. B. Weaver Fellow in Anatomy
William E. Loechel U.S.P.H. Fellow in Medical Art
64 UNIVERSITY OF MARYLAND
Gross Anatomy. First Year. First semester. The gross structure of the
human body, studied by dissection of the human cadaver. The entire human
body is dissected. Approximately 370 hours; of these 80 hours are devoted to
lectures and conferences, the rest to laboratory work and demonstrations. Drs.
Uhlenhuth, Krahl, Mech, McCafferty, Phelan and Miss Wadsworth.
First Year. First Semester. Peripheral Nervous System. A lecture course
of approximately 32 hours, in two-hour periods each Saturday morning. Dr.
Uhlenhuth.
Histology and Embryology First Year. First Semester. The Microscopic
Structure of the Organs, Tissues and Cells of the Human Body.
This course will present an integrated study of the histology and embryology
of the human body, but most of the time is devoted to the study of histology.
An attempt will be made to correlate this with gross anatomy as well as other
subjects in the medical curriculum. Special emphasis will be placed on the dy-
namic and functional aspects of the subject. 150 hours. Dr. Figge, Prof. Harne,
Drs. Lutz, Mack, Brunst and Miss Wolfe.
Neuroanatomy. First Year. Second Semester. The Central Nervous Sys-
tem. The study of the detailed anatomy of the central nervous system will
be coordinated with the structure and function of the entire nervous system. This
study will require the dissection of a human brain and the examination of stained
microscopic sections of various levels of the brain stem. 100 hours. Dr. Figge,
Prof. Harne, Drs. Lutz, Mack, Smith and Miss Wolfe.
Surgical Anatomy. Second Year. Second Semester. Topographic and
Surgical Anatomy. The course is designed to bridge the gap between abstract
anatomy and clinical anatomy as applied to the study and practice of medicine
and surgery. Students are required to dissect and demonstrate all points, out-
lines and regions of the cadaver. Underlying regions are dissected to bring out-
lines and relations of structures. Dr. Brantigan and staff.
Total hours: 96
Graduate and Postgraduate Courses. Consult the general catalog of the
University of Maryland for descriptions of these courses.
ART AS APPLIED TO MEDICINE
Carl Dame Clarke Associate Professor of Art as Applied to Medicine
Thomas M. Stevenson, Jr Assistant in Art as Applied to Medicine
Jane L. Bleakley Assistant in Art as Applied to Medicine
Raymond J. Clayton, Jr Assistant in Art as Applied to Medicine
Shirley K. Fitzgerald Assistant in Art as Applied to Medicine
Jenifred S. Boehm Assistant in Art as Applied to Medicine
This department is maintained for the purpose of supplying pictorial and plastic
illustrations for visual teaching in the classrooms of the medical school and for
publication in scientific periodicals. Research in prosthetics and the production
of prosthetic appliances are also carried out in this department.
Special courses of instruction are given to qualified students.
SCHOOL OF MEDICINE 65
BACTERIOLOGY AND IMMUNOLOGY
Frank W. Hachtel Professor of Bacteriology and Head of the Department
Lloyd D. Felton Visiting Research Professor of Bacteriology
Edward Steers Associate Professor of Bacteriology
Andrew G. Smith Assistant Professor of Bacteriology
rL Edmund Levin Associate in Bacteriology
Merrill J. Snyder Instructor in Bacteriology
Joseph R. Merkel Research Assistant in Bacteriology
Ernest C. Herrmann, Jr Research Assistant in Bacteriology
Richard E. Brown Research Assistant in Bacteriology
Bernard Kramer Research Assistant in Bacteriology
Second Year. First Semester. The principles of general bacteriology are
taught by quiz, conference, and lecture,
Instruction given in the laboratory includes the methods of preparation of
culture media, the study of pathogenic bacteria, and the bacteriological examina-
tion of water and milk. The bacteriological diagnosis of communicable diseases
is also included.
Second Year. Second Semester. The principles of immunology are presented
by means of quizzes, conferences and lectures.
The course includes a consideration of infection and immunity, the nature and
action of the various antibodies, complement fixation and flocculation tests, hyper-
sensitiveness, and the preparation of bacterial vaccines.
Experiments are carried out by the class in the laboratory. During the latter
half of the semester the class is divided into sections.
Total hours: Bacteriology 120.
Immunology 72.
Graduate Courses. Consult the catalogue of the Graduate School for descrip-
tions of the graduate courses offered by members of the staff.
BIOLOGICAL CHEMISTRY
Emil G. Schmidt Professor of Biological Chemistry and Head of the Department
Edward J. Herbst Assistant Professor of Biological Chemistry
Raymond E. Vanderlinde Assistant Professor of Biological Chemistry
William H. Summerson Lecturer in Biological Chemistry
Ann Virginia Brown Instructor in Biological Chemistry
Jean D. Nimmo Research Assistant in Biological Chemistry
Eleanor B. Glinos Research Assistant in Biological Chemistry
Dorothy D. Hubbard. . .Williams Research Corporation Fellow in Biological Chemistry
Gerald Kessler Nutrition Foundation Fellow in Biological Chemistry
Robert G. Leonard, B.S., M.S Bressler Reserve Fund Fellow in Biological Chemistry
First Year. Second Semester. This course is designed to present the prin-
ciples of biological chemistry and to indicate their applications to the clinical
aspects of medicine. The phenomena of living matter and its chief ingredients,
secretions and excretions are discussed in lectures and conferences and examined
experimentally. Training is given in biochemical methods of investigation. Total
hours: 208.
66 UNIVERSITY OF MARYLAND
Graduate Courses. Consult the catalogue of the Graduate School for descrip-
tions of the graduate courses offered by members of the staff.
CARDIOLOGY [a division of medicine]
In the third year a series of lectures and clinics correlated with pathological
studies is given the entire class.
In the fourth year students are assigned for two periods weekly for five weeks
to the Cardiac Clinic and attend consultation rounds and conferences on cardio-
vascular cases on the Medical wards.
CLINICAL PATHOLOGY [a division of medicine]
Milton S. Sacks Associate Professor of Medicine and Head of
the Division of Clinical Pathology
Sol Smith Assistant Professor of Medicine
Marie A. Andersch Biochemist, University Hospital, Associate in Medicine
S. Edwin Muller Associate in Medicine
L. Ann Hellen Instructor in Medicine
Audrey M. Funk Instructor in Medicine
Perry O. Futterman Instructor in Medicine
Charles P. Barnett Baltimore Rh Laboratory Fellow in Medicine
Third Year. First and second semesters. The course in Clinical Pathology is
designed to train the student in the performance and interpretation of fundamental
diagnostic laboratory procedures used in clinical medicine.
During the first semester the work is devoted to a thorough consideration of dis-
eases of the hematopoietic system. In the second semester, laboratory work in
urinalysis, gastric analysis, hepatic, pancreatic and renal functions, together with
a thorough discussion of underlying biochemical and physiological mechanisms is
undertaken. During this semester examination of cerebrospinal fluid, transudates
and exudates is included. Elements of clinical parasitology complete the work in
this semester.
Each student provides his own microscope and blood counting equipment. A
completely equipped locker is assigned to every student.
Total Hours: 128.
Fourth Year. During the fourth year the student applies in the laboratories of
the various affiliated hospitals the knowledge acquired during the preceding year.
A completely equipped locker is assigned enabling him to work independent of
the general laboratories. Instructors are available during certain hours to give
necessary assistance and advice.
DENTISTRY [a division of surgery]
^rice M. Dorsey Professor of Oral Surgery
xMyron S. Aisenberg Professor of Pathology
1 Faculty Member, School of Dentistry.
SCHOOL OF MEDICINE 67
'Joseph C. Biddix, Jr Professor of Oral Diagnosis
'Kyrle W. Preis Professor of Orthodontics
'Harry M. Robinson, Sr Professor of Dermatology
'Grayson W. Gaver Professor of Dental Prosthesis
'Ernest B. Nuttall Professor of Crown and Bridge
'Kenneth V. Randolph Professor of Operative Dentistry
'Edward C. Dobbs Professor of Pharmacology
George H. Yeager Professor of Clinical Surgery
Grant E. Ward Associate Professor of Surgery and Oral Surgery
'Hugh H. Hicks Associate Professor of Periodontology
'Lewis C. Toomey Associate Professor of Oral Surgery
George McLean Assistant Professor of Medicine
'Wilbur O. Ramsay Assistant Professor of Clinical Dental Prosthesis
'Samuel H. Bryant Instructor in Oral Diagnosis
'Russell Gigliotti Instructor in Clinical Oral Diagnosis
'Joseph P. Cappuccio Instructor in Oral Surgery
'Conrad L. Inman Instructor in Anesthesiology
This section has been reorganized for the teaching of both medical and dental
students. There has been established a division in the out-patient department,
and beds will be provided in the University Hospital, for the care of patients who
will be available for the teaching of students from both schools.
Senior year: clinics weekly.
Ward instruction and group teaching are given. This includes diagnosis and
treatment of diseases of the face, mouth and jaws.
DERMATOLOGY AND SYPHLLOLOGY [a division of medicine]
Harry M. Robinson, Sr Professor of Dermatology
Francis A. Ellis Assistant Professor of Dermatology
Harry M. Robinson, Jr Assistant Professor of Dermatology
Eugene S. Bereston Associate in Dermatology
A Albert Shapiro Associate in Dermatology
Israel Zeligman Associate in Dermatology
R. C. V. Robinson Associate in Dermatology
William R. Bundick '.. Associate in Dermatology
Lucile J. Caldwell Instructor in Dermatology
Mark B. Hollander Instructor in Dermatology
V. Harwood Link Instructor in Dermatology
Morris M. Cohen Instructor in Dermatology
Lee R. Lerman Assistant in Dermatology
The third year class receives six lecture-demonstrations on the principles of
dermatology by Dr. Robinson.
The senior course consists of conferences and demonstrations of the common
skin diseases and venereal diseases in the outpatient dermatologic and syphilis
clinics and on the medical wards.
68 UNIVERSITY OF MARYLAND
GASTROENTEROLOGY [a division of medicine]
Theodore H. Morrison Clinical Professor of Gastro-Enterology
Samuel Morrison Associate Professor of Gastro-Enterology
Maurice Feldman Assistant Professor of Gastro-Enterology
Zachariah Morgan Assistant Professor of Gastro-Enterology
Francis G. Dickey Associate in Medicine
Z. Vance Hooper Associate in Gastro-Enterology
Albert J. Shochat Instructor in Gastro-Enterology
Philip D. Flynn Instructor in Medicine
Alfred S. Lederman Assistant in Gastro-Enterology
Third Year. A series of six lectures is given on the diseases of the digestive
tract.
Fourth Year. Students attend the gastro-intestinal clinic for two periods weekly
for five weeks, and consultation rounds on gastro-intestinal cases on the Medical
wards. Practical instruction is given in the use of modern methods of study of
the diseases of the gastro-intestinal tract.
GYNECOLOGY
J. Mason Hundley, Jr Professor of Gynecology, and Head of the Department
Leo Brady Assistant Professor of Gynecology
Edward P. Smith Assistant Professor of Gynecology
William K. Diehl Assistant Professor of Gynecology
Everett S. Diggs Assistant Professor of Gynecology
Beverley C. Compton Assistant Professor of Gynecology
Ernest I. Cornbrooks, Jr Assistant Professor of Gynecology
John C. Dumler Assistant Professor of Gynecology
J. J. Erwin Associate in Gynecology
Frank K. Morris. Associate in Gynecology
Gerald A. Galvin Associate in Gynecology
John T. Hibbitts Associate in Gynecology
Kenneth B. Boyd Associate in Gynecology
Theodore Kardash Instructor n Gynecology
Charles B. Marek Instructor in Gynecology
Thomas S. Bowyer Instructor in Gynecology
Ernest S. Edlow Instructor in Gynecology
W. Allen Deckert Instructor in Gynecology
Helen I. Maginnis Instructor in Gynecology
Charles H. Doeller, Jr Instructor in Gynecology
William A. Dodd Instructor in Gynecology
Harry McB. Beck Instructor in Gynecology
William C. Duffy Instructor in Gynecology
Joseph C. Sheehan Instructor in Gynecology
William J. Rysanek Instructor in Gynecology
Harry F. Kane Instructor in Gynecology
Robert B. Tunney Instructor in Gynecology
Thomas A. Stebbins Medical Illustrator in Oncology and Gynecology
James H. Shell Hitchcock Fellow in Gynecology
SCHOOL OF MEDICINE 69
Third Year. A comprehensive course of 30 lectures in the field of gynecology,
female urology, and female oncology is given to the entire class.
Fourth Year. An intensive course is given to small groups of students through-
out the year, during which time the students are assigned exclusively to this
department. The course consists of instructions including lectures, seminars,
ward rounds, and operative clinics. In addition, two special instruction periods
are given in pathology at which time a review of the pathological material seen
at operation is made with especial reference to the pathology of malignant disease.
The students are assigned patients on the gynecological wards, and also work
in the gynecological, cystoscopy and oncology dispensaries each day.
Third year 30 hours
Fourth year 75 hours
Total: 105 hours
HISTORY OF MEDICINE
Louis A. M. Krause Professor of Clinical Medicine
Beginning with the spring of 1942 a group of lectures on the history of medicine
has been presented on selected phases and trends of the development of medical
knowledge and practice. It is planned to avoid duplication of subject matter
for at least four years.
These lectures are offered primarily for our students, but a cordial invitation
is extended to anyone who may wish to attend.
Announcement of the lectures will be made by mail and on the bulletin
board of the School of Medicine.
HYGIENE AND PUBLIC HEALTH [a division of medicine]
Huntington Williams Professor of Hygiene and Public Health
William H. F. Warthen Associate Professor of Hygiene and Public Health
Ross Davtes Associate Professor of Hygiene and Public Health
Third Year. A one-hour lecture is given to the whole class each Tuesday during
both semesters. Basic instruction is afforded in the clinical and public health
aspects of the communicable diseases including syphilis and tuberculosis. The
lectures are under the auspices of the Department of Medicine and are given by
staff members of that department, including physicians representing pediatrics,
hygiene and public health, and by staff members of the Baltimore City Health
Department.
Fourth Year. Elective work is also assigned at the Western Health District
Building of the City Health Department, 617 West Lombard Street, where the
District Health Officer arranges for home visiting and the student prepares and
presents a Home Survey Report.
The course deals with the fundamentals of public health and supplements the
work in the third year. The major emphasis in both years is on the practice of
70 UNIVERSITY OF MARYLAND
preventive medicine and the relation of prevention to diagnosis and treatment,
and on the civic and social implications of the medical services.
INDUSTRIAL MEDICINE AND SURGERY [a division of surgery]
Professor of Clinical Medicine
Charles A. Reifschneider Clinical Professor of Traumatic Surgery
Thurston R. Adams Assistant Professor of Surgery
This section is under the combined supervision of the medical and surgical
departments. It is a cooperative effort by members of the medical school and
hospital staff to afford means for clinical and laboratory study of the patient who
has been subjected to traumatic or medical industrial hazard, so that adequate
care may be instituted to promote his physical well-being. The faculties of the
laboratories of the medical school and hospital are available as required.
Under direction of this department limited undergraduate instruction is given,
especially in the methods of examination and of keeping records and in the general
medico-legal principles as they affect the industrial employee, the employer, the
general insurers, the physician and the hospital. There is also instruction on
methods of making life insurance and other physical examinations, whether for
employment or for health purposes. The wards of the University, Mercy and
Baltimore City Hospitals provide for bed-side instruction.
Total hours: 8.
LEGAL MEDICINE [a division of medicine]
Russell S. Fisher Associate Professor of Legal Medicine
Henry C. Freimuth Associate in Legal Medicine
Stanley H. Durlacher Associate in Legal Medicine
William J. McClafferty Associate in Legal Medicine
William V. Lovttt, Jr Instructorin Legal Medicine
Third Year. This course embraces a summary of medical jurisprudence in-
cluding the laws governing the practice of medicine, industrial compensation
and malpractice, proceedings in criminal and civil prosecution, medical evidence
and testimony, identification of bodies, injuries by blunt force, gunshot and other
mechanisms, natural and homicidal deaths, medicolegal toxicology and the medico-
legal autopsy. (12 hours.)
Elective Course (summer). A small number of students may upon application
be assigned to elective work in the laboratory of the Chief Medical Examiner of
the State of Maryland.
MEDICINE
Maurice C. Pincoffs Professor of Medicine and Head of the Department
T. Nelson Carey Professor of Clinical Medicine
Thomas P. Sprunt Professor of Clinical Medicine
H. Raymond Peters Professor of Clinical Medicine
Louis A. M. Krause Professor of Clinical Medicine
William S. Love, Jr Associate Professor of Medicine
SCHOOL OF MEDICINE 71
Thomas C. Wolff Associate Professor of Medicine
Howard M. Bubert Associate Professor of Medicine
J. Sheldon Eastland Associate Professor of Medicine
Milton S. Sacks Associate Professor of Medicine
Lewis P. Gundry Associate Professor of Medicine
Samuel Morrison Associate Professor of Medicine
Theodore E. Woodward Associate Professor of Medicine
William H. Smith Associate Professor of Clinical Medicine
George McLean Assistant Professor of Medicine
Wetherbee Fort Assistant Professor of Medicine
Frank J. Geraghty Assistant Professor of Medicine
H. Vernon Langeltjttig Assistant Professor of Medicine
Sol Smith Assistant Professor of Medicine
Edward F. Cotter Assistant Professor of Medicine
C. Edward Leach Assistant Professor of Medicine
Ephraim T. Lisansky Assistant Professor of Medicine
Samuel T. R. Revell, Jr Assistant Professor of Medicine
Henry J. Marriott Assistant Professor of Medicine
Robert A. Reiter Assistant Professor of Medicine
Samuel Legum Associate in Medicine
W. Grafton Herspberger Associate in Medicine
Meyer W. Jacobson Associate in Medicine
Conrad B. Acton Associate in Medicine
Francis G. Dickey Associate in Medicine
Lawrence M. Serra Associate in Medicine
Marie A. Anderesch Associate in Medicine and Lecturer in Biological Chemistry
Harry M. Robinson, Jr Associate in Medicine
William K. Waller Associate in Medicine
Arthur Karfgin Associate in Medicine
M. Paul B yerly Associate in Medicine
Henry W. D. Holljes. Associate in Medicine
S. Edwin Muller Associate in Medicine
Sidney Scherlis Associate in Medicine
Kurt Levy. Associate in Medicine
Wilfred H. Townshend Associate in Medicine
Alvin J. Hartz Associate in Medicine
James R. Karns Associate in Medicine
Edmund G. Beacham Associate in Medicine
Richard A. Carey Associate in Medicine
Louis V. Blum Associate in Medicine
Leon Ashman Associate in Medicine
Louis Kroll Associate in Medicine
Daniel Wilfson, Jr Associate in Medicine
Jonas Cohen Associate in Medicine
Walter Karfgln Associate in Medicine
Irving Freeman Associate in Medicine
Philip D. Flynn Instructor in Medicine
Edward S. Kallins Instructor in Medicine
John A. Myers Instructor in Medicine
72
UNIVERSITY OF MARYLAND
William G. Helfrich Instructor
Joseph E. Muse Instructor
William H. Kammer, Jr Instructor
Samuel J. Hankin Instructor
Frederick J. Vollmer Instructor
John R. Davis Instructor
John B. deHoff Instructor
Charles F. Brambel Instructor
L. Ann Hellen Instructor
Audrey M. Funk Instructor
J. Emmett Queen Instructor
Leon A. Kochman Instructor
Robert E. Bauer Instructor
C. Herman Williams Instructor
Jerome Sherman Instructor
Perry 0. Futterman Instructor
Elizabeth D. Sherrill Instructor
Philip D. Flynn Instructor
Joseph Furnari Instructor
Robert T. Parker Instructor
Morris Fine Instructor
Stephen J. Van Lill, III Instructor
Stuart D. Sunday Instructor
Irvin B. Kemick Instructor
Maurice Feldman, Jr Instructor
James J. Nolan Instructor
Charles E. Shaw Instructor
Joseph G. Bird Instructor
Rollin C. Hudson Assistant
Franklin E. Leslie Assistant
John C. Osborne Assistant
Raymond M. Lauer Assistant
Lauriston L. Keown Assistant
Burton V. Lock Assistant
Carl F. Myers Assistant
Jack Wexler Assistant
Bernard Burgin Assistant
Marvin Goldstein Assistant
Donald Mintzer Assistant
Franklin Leslie Assistant
Joseph C. Myers Assistant
Thomas Worsley Assistant
Edward S. Kallins Assistant
Joseph B. Workman Research Fellow
Charles P. Barnett Baltimore Rh Typing Laboratory Fellow
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
in Medicine
. in Medicine
. in Medicine
in Medicine
in Medicine
. in Medicine
. in Medicine
. in Medicine
. in Medicine
; in Medicine
in Medicine
in Medicine
Second Year
Introduction to clinical medicine.
(a) Introductory physical diagnosis. (1 hour a week, first semester; 2 hours a week,
second semester.)
(b) Medical clinics. (1 hour a week, second semester.)
SCHOOL OF MEDICINE 73
Third Year
I. The methods of examination: (a) History taking, (b) Physical diagnosis, (c)
Clinical pathology.
Instruction includes lectures and practice in the wards, outpatient department and
laboratory.
II. The principles of medicine:
(a) Lectures, clinics and demonstrations in general medicine, neurology, and pre-
ventive medicine.
Third Year teaching of physical diagnosis is carried out chiefly in the various units
of the City Hospital.
Fourth Year
The practice of medicine :
I. Clinical clerkship on the medical wards (31 hours a week for ten weeks).
(a) Responsibility, under supervision, for the history, physical examination,
laboratory examinations and progress notes of assigned cases.
(b) Ward classes, ward rounds and conferences in general medicine, the medical
specialties, and therapeutics.
II. Dispensary work in the medical specialties.
III. Clinical-pathological conferences (1 hour a week).
The medical dispensary of the University Hospital is utilized for teaching in the
third year. Each student spends two hours daily for ten weeks in dispensary work.
The work is done in groups of four to six students under an instructor. Systematic
history-taking is especially stressed. Physical findings are demonstrated. The
student becomes familiar with the commoner acute and chronic disease processes.
Clinical clerkships in the Fourth Year are served on the medical wards of both
the University and Mercy Hospitals.
NEUROLOGICAL SURGERY [a division of surgery]
Charles Bagley, Jr Professor of Neurological Surgery
Richard G. Coblentz Professor of Clinical Neurological Surgery
James G. Arnold, Jr Associate Professor of Neurological Surgery
John A. Wagner Associate Professor of Pathology and Neuropathology
Robert Oster
Associate in Electro-physiology, and Director of the Hoffberger Electroencephalo-
graphic Laboratory
Raymond K. Thompson
Associate in Neurological Surgery, Director of Neurological Surgery Research
Frank J. Otenasek Instructor in Neurological Surgery
John W. Chambers Instructor in Neurological Surgery
Louis O. J. Manganiello
Research Fellow, Fund B, assigned to Neurological Surgery, Exchange Resident
in Neurosurgery, Baltimore City Hospitals
Robert M. N. Crosby Fellow in Neurological Surgery
Pomeroy Nichols, Jr Fellow in Neurological Surgery
Third year. The course covers instruction in diagnosis and treatment of
surgical conditions of the brain, spinal cord and the peripheral nerves. Drs.
Bagley, Coblentz, Arnold and Thompson.
74 UNIVERSITY OF MARYLAND
Fourth year. Weekly ward rounds and conferences are given at the University
Hospital. Drs. Bagley, Coblentz, Arnold and Thompson. Instruction is given
(elective) in the out-patient dispensary by Drs. Louis Manganiello, George Smith
and Jose A. Alvarez.
Third year 12 hours
Fourth year 15 hours
Conference and ward rounds (elective) 32 hours
Neurological Surgery Dispensary (elective) 48 hours
Total 107 hours
NEUROLOGY
Leon Freedom Associate Professor of Neurology
Philip F. Lerner Assistant Professor of Neurology
William L. Fearing Associate in Neurology
Edward F. Cotter Associate in Neurology
Harry Teitelbaum Associate in Neurology
George G. Merrill Associate in Neurology
Second Year. Fifteen one-hour lectures are given to correlate the anatomy
and physiology of the nervous system with clinical neurology.
Third Year. Twenty hours of instruction are given to the whole class in neuro-
pathology supplemented with pathological demonstrations. Sixteen lecture-
demonstrations are given in which the major types of the diseases of the nervous
system are discussed. A course is also given at the Baltimore City Hospitals,
comprising eight periods of two hours each, in which the students in small groups
carry out complete neurological examinations of selected cases which illustrate
the chief neurological syndromes.
Fourth Year. Fourth year students in the Medical section attend neurological
consultation rounds on ward patients in the University and Mercy Hospitals.
All patients presented at these clinics are carefully examined.
Dispensary Instructions. Small sections are instructed in the neurological dis-
pensary of the Mercy Hospital five afternoons each week. In this way students
are brought into contact with nervous diseases in their early and late manifesta-
tions.
OBSTETRICS
Louis H. Douglass Professor of Obstetrics and Head of the Department
J. Morris Reese Associate Professor of Obstetrics
D. Frank Kaltreider Associate Professor of Obstetrics
Isadore A. Siegel Assistant Professor of Obstetrics
John E. Savage '. Assistant Professor of Obstetrics
Hugh B. McNally Assistant Professor of Obstetrics
Margaret B. Ballard Associate in Obstetrics
D. McClelland Dixon Associate in Obstetrics
Osborne C. Christensen Associate in Obstetrics
J. Tyler Baker Associate in Obstetrics
J. Huff Morrison Associate in Obstetrics
George H. Davis Instructor in Obstetrics
J. King B. E. Seegar Instructor in Obstetrics
SCHOOL OF MEDICINE 75
Louis C. Gareis Instructor in Obstetrics
Kenneth B. Boyd Assistant in Obstetrics
W. Kenneth Mansfield, Jr Assistant in Obstetrics
Charles H. Doeller, Jr Assistant in Obstetrics
Theodore Kardash Assistant in Obstetrics
Harry McB. Beck Assistant in Obstetrics
William A. Dodd Assistant in Obstetrics
Irvin P. Klemkowski Assistant in Obstetrics
Clarence W. Martin Assistant in Obstetrics
Vernon C. Kelley Assistant in Obstetrics
Harry Cohen Assistant in Obstetrics
Second Year: During the second semester lectures are given one hour weekly.
Students are oriented on the normal pelvis, generative tract and the physiology
of pregnancy and labor. The conduct of normal delivery and the puerperium are
explained, and in general an attempt is made to prepare the student for the prac-
tical training he is to receive in his third year. Drs. Douglass and Kaltreider.
Third Year: Lectures and recitations consist of 3 hours teaching weekly and
are designed to cover the anatomy more completely, especially that of the bony
pelvis from an obstetrical point of view. Physiology of the endocrine system is
reviewed as it relates to pregnancy and the growth and development of the im-
pregnated ovum. Following this the pathology of pregnancy, labor and the puer-
perium are considered. Drs. Douglass, Reese, Siegel, Savage, Dixon and
Kaltreider.
Each student is required to spend 4 days on the obstetrical service of the Balti-
more City Hospitals during his junior year. Here he acts as a junior intern, ob-
serving, assisting and finally delivering normal cases under supervision. Each
student attends a total of about 25 deliveries, in the majority of which he takes an
active part.
Each student receives, as a member of a small group, 10 hours of instruction in
palpating patients, in the clinical evaluation of the pelvis and in demonstrations
of the mechanism of labor. Drs. Siegel and McNally.
Fourth Year: The instruction is entirely clinical. The "block system" is used.
One-sixteenth of the class is assigned to obstetrics only for a period of 2 weeks.
Students live at the University Hospital during this time and are on call 24 hours
a day. They receive formal class instruction, are required to attend all rounds
and staff conferences and are present at the majority of the deliveries as observers,
assistants or as accoucheurs. In this way each student will actively participate
in about 15 deliveries. Operative work on an obstetrical mannikin is an organized
part of the course. Each student receives 6 hours of this type of instruction.
Each student spends 20 hours in the prenatal and postnatal clinics, where in-
structions in these fields are given.
Students assigned to obstetrics are required to attend the monthly meetings of
The Committee on Maternal Mortality of Baltimore, where all maternal deaths
occurring in this city are presented and discussed.
Second year — 16 Third year — 148
Fourth year— 106 Total —270
76 UNIVERSITY OF MARYLAND
ONCOLOGY [a division of gynecology and surgery]
J. Mason Hundley, Jr Professor of Gynecology
Beverley C. Compton Assistant Professor of Gynecology
William K. Diehl Assistant Professor of Gynecology
Everett S. Diggs Assistant Professor of Gynecology
Ernest I. Cornbrooks, Jr Assistant Professor of Gynecology
Arthur G. Si vvinski Assistant Professor of Surgery
John C. Dumler Assistant Professor of Gynecology
Edwin H. Stewart Associate in Surgery
J. Duer Moores Instructor in Surgery
Louis F. Goodman Instructor in Surgery
Girardo B. Polanco National Cancer Institute Trainee in Pathology
E. Eugene Covington Assistant Radiologist
Thomas A. Stebbins Medical Illustrator in Oncology and Gynecology
The purpose of the courses in Oncology is to give students training in the
diagnosis and treatment of neoplastic diseases not obtained in other departments
and at the same time to correlate this training with that received in surgery,
medicine, roentgenology and other specialties.
Third year. Six didactic lectures are given on the diagnosis and treatment of
cancer of the generative organs. Dr. Hundley and staff.
Five lectures in general oncology are given to the entire Junior Class at the end
of the year. The increasing importance of the cancer problem is emphasized.
The biological aspects of cancer and the relation of hormones, carcinogenic agents,
and etiological factors are discussed. The gradation of neoplasms, and the bio-
physical effects of irradiation therapy are presented. The diagnosis, surgical
and radiological treatment of neoplasms of the head and neck, oral cavity, skin,
breasts, and hemopoietic system are discussed. Dr. Ward and staff.
Fourth Year. Ten senior students of the University section are assigned to the
Oncology clinic. Five students are assigned to the Tuesday morning clinic, and
the alternate group to the Friday morning clinic. The diagnosis and treatment,
both surgical and radiological are discussed in the presence of a staff member of
the departments of Pathology, Radiology, and Surgery.
An outpatient Gynecological Clinic is held bi-weekly which affords an opportu-
nity for instruction of small groups of students, which are assigned in rotation, in
the various phases of malignancy of the generative organs. Weekly ward rounds
and operative clinics are held for seniors.
Onocology Gynecology Total
Third year '. 5 hours 6 hours 1 1 hours
Fourth year 12 hours 16 hours 28 hours
Total 17 hours 22 hours 39 hours
OPHTHALMOLOGY
F. Edwin Knowles, Jr.
Assistant Professor of Ophthalmology and Chairman of the Department
SCHOOL OF MEDICINE 77
Joseph I. Kemler Associate in Ophthalmology
A. Kremen Associate in Ophthalmology
Paul N. Friedman Instructor in Ophthalmology
Ruby A. Smith Instructor in Ophthalmology
D. J. McHenry Instructor in Ophthalmology
F. E. Brtjmback Instructor in Ophthalmology
Richard J. Cross Instructor in Ophthalmology
John C. Ozazewski Assistant in Ophthalmology
Third Year. Second semester. Dr. Friedman reviews the anatomy and physi-
ology of the eye and discusses the methods used in making the various exami-
nations. Errors of refraction and their effect upon the general system are explained.
Weekly section work, demonstrating the use of the ophthalmoscope, with the aid
of kodachrome transparencies of the fundus oculi is carried on during the entire
session at the Baltimore Eye, Ear, and Throat Hospital by Dr. Kremen.
Fourth Year. Clinics and demonstrations are given in diseases of the eye,
twice weekly, for one year. Dr. Knowles.
The course consists of instruction in the clinic to small groups of students four
days a week for four weeks. During this period, the student examines patients,
diagnoses and treats various ocular diseases, under the supervision of Drs. Knowles,
Smith, Brumback, Friedman and Ozazewski. Twice weekly lectures and lantern
slide demonstration are given upon diseases of the eye, with particular reference
to their diagnosis, management and relation to general medicine. Special lec-
tures are given the entire class on vascular changes in the eye, refraction, cata-
ract and neuro-ophthalmology. Certain operations are demonstrated by motion
pictures.
Weekly ward classes are held at the University and Mercy Hospitals during
which the eye grounds in the various medical and surgical conditions are demon-
strated. Drs. Knowles, Kemler, Kremen, Smith, Brumback, Jeppi and Pacienza.
Third year 20 hours
Fourth year 41 hours
Total 61 hours
ORTHOPAEDICS [a division of surgery]
Allen Fiske Voshell Professor of Orthopaedic Surgery
Harry L. Rogers Clinical Professor of Orthopaedic Surgery
Moses Gellman .Associate Professor of Orthopaedic Surgery
Henry F. Ullrich Associate Professor of Orthopaedic Surgery
Milton J. Wilder Assistant Professor in Orthopaedic Surgery
I. H. Maseritz Associate in Orthopaedic Surgery
Jason H. Gaskel Instructor in Orthopaedic Surgery
Isaac Gutman Instructorin Orthopaedic Surgery
James P. Miller Instructor in Orthopaedic Surgery
Everett D. Jones Assistant in Orthopaedic Surgery
Robert C. Abrams Assistant in Orthopaedic Surgery
Didactic instruction is given in the second, third and fourth years. Clinical,
78 UNIVERSITY OF MARYLAND
bedside and outpatient instruction is given at the University, Mercy Hospitals
and their Outpatient Departments, Kernan Hospital for Crippled Children, and
Baltimore City Hospitals. Brief discussions and demonstrations of physical and
occupational therapy are included in the course.
Second year 19 hours
Third year 36 hours
Fourth year 90 hours
Total 145 hours
OTOLARYNGOLOGY [a division of surgery]
Edward A. Looper Professor of Otolaryngology and Head of the Department
Waitman F. Zinn Professor of Otolaryngology
Thomas R. O'Rourk Professor of Otolaryngology
Frederick T. Kyper Associate Professor of Otolaryngology
Benjamin S. Rich Associate Professor of Otolaryngology
Fayne A. Kayser Associate Professor of Otolaryngology
W. Raymond McKenzee Assistant Professor of Otolaryngology
Theodore A. Schwartz Assistant Professor of Otolaryngology
Robert Z. Berry Associate in Otolaryngology
Arthur Ward Associate in Otolaryngology
John H. Herschfeld Assistant in Otolaryngology
Benjamin H. Isaacs Associate in Otolaryngology
Samuel L. Fox Associate in Otolaryngology
Richard J. Cross Instructor in Otolaryngology
Third Year. Instruction to the whole class is given in the common diseases of
the nose and throat, attention being especially directed to infections of the accessory
sinuses, the importance of focal infections in the etiology of general diseases and
modern methods of diagnosis. Lectures illustrated by lantern slides are given
one hour weekly for eight weeks by Dr. Looper.
Fourth Year. Dispensary instruction is given for three hours daily, to small
sections at the University and the Mercy Hospitals. The student is afforded an
opportunity to study, diagnose and treat patients under supervision. Ward classes
and clinical demonstrations are given in periods of one and one-half hours weekly
throughout the session in the University and Mercy Hospitals.
The Looper Clinic for bronchoscopy and esophagoscopy, recently established
in the University Hospital, affords unusual opportunities for students to study
diseases of the larynx, bronchi and esophagus. The clinic is open to students
daily from 2 to 4 P.M. under direction of Dr. Looper, and associates.
The Mercy Hospital clinic for bronchoscopy and esophagoscopy is under the
direction of Dr. Zinn. In these two clinics the etiology, symptomatology, diag-
nosis and treatment of foreign bodies in the air and food passages, as well as
bronchoscopy, are taught to students as an aid in the diagnosis and treatment of
diseases of the lungs.
Third year 9 hours
Fourth year 53 hours
Total 62 hours
SCHOOL OF MEDICINE 79
OTOLOGY [a division of surgery]
Thomas R. O'Rourk Professor of Otolaryngology
The course in otology is planned to give a practical knowledge of the anatomy
and physiology of the ear, and its proximity and relationship to the brain and other
vital structures. The inflammatory diseases, their etiology, diagnosis, treatment
and complications are particularly stressed, with emphasis upon their relationship
to the diseases of children, head-surgery and neurology
Third Year. The whole class is given instruction by means of talks, anatomical
specimens and lantern slides. Dr. O'Rourk and associates.
Fourth Year. Small sections of the class receive instruction and make personal
examinations of patients under the direction of an instructor. The student is
urged to make a routine examination of the ear in his ward work in general medi-
cine and surgery. Dr. O'Rourk and associates.
Third year 12 hours
Fourth year . 40 hours
Total 52 hours
PATHOLOGY
Hugh R. Spencer Professor of Pathology and Head of the Department
Robert B. Wright Associate Professor of Pathology
C. Gardner Warner Associate Professor of Pathology
Walter C. Merkel Associate Professor of Pathology
Dexter L. Reimann Associate Professor of Pathology
John A. Wagner Associate Professor of Pathology
Albert E. Goldstein Assistant Professor of Pathology
Milton S. Sacks Associate in Pathology
Benedict Skitarelic Associate in Pathology
Charles P. Barnett Associate in Pathology
Conrad B. Acton Instructor in Pathology
Howard B. Mays Instructor in Pathology
Ephraim T. Lisansky Instructor in Pathology
D. McClelland Ddcon Instructor in Pathology
William B. VandeGriet Instructor in Pathology
William J. Bryson Instructor in Pathology
Karl F. Mech Instructor in Pathology
Seymour W. Rubin Instructor in Pathology
Theodore Kardash Instructor in Pathology
Louis C. Gareis Instructor in Pathology
Roy B. Turner Instructor in Pathology
Edward L. J. Kreig Instructor in Pathology
James H. Ramsey Assistant in Pathology
Harry Cohen Assistant in Pathology
Gerardo B. Polanco National Cancer Institute Trainee
Courses of instruction in pathology are given during the second and third years.
The courses are based on the previous study of normal structure and function and
aim to outline the history of disease. The relationship between clinical symptoms
and anatomical lesions is constantly stressed.
80 UNIVERSITY OF MARYLAND
General Pathology. Second Semester, Second Year. This course includes
the study of disturbances of the body fluids; disturbances of structure, nutrition
and metabolism of cells; disturbances of fat, carbohydrate and protein metab-
olism; disturbances of pigment metabolism; inflammation and tumors.
Laboratory instruction is based on the study of prepared slides (loan collection)
and corresponding gross material.
Applied Pathology, Including Gross Morbid Anatomy and Morbid
Physiology. Third Year. The laboratory instruction in this course is carried
out in small teaching museums where prepared specimens and material from au-
topsies with clinical histories and sections are available for study. For this work
the class is divided into small groups. Clinical correlation is stressed.
Autopsies. Third Year. Students in small groups attend autopsies at the
morgues of the University Hospital and the Baltimore City Hospitals.
Clinical-Pathological Conference. {Fourth Year.) These exercises are
held in collaboration with the various clinical departments. Selected cases are
discussed and autopsy findings are presented.
Second year 184 hours
Third year 160 hours
Fourth year 30 hours
Total 374 hours
PEDIATRICS
J. Edmund Bradley Professor of Pediatrics and Head of the Department
C Lortng Joslin Professor of Pediatrics
A. H. Finkelstein Associate Professor of Pediatrics
Frederick B. Smith Associate Professor of Pediatrics
Gordon E. Gibbs Associate Professor Clinical Research
Albert Jaffe Associate Clinical Professor of Pediatrics
Samuel S. Glick Assistant Professor of Pediatrics
Jerome Fineman Assistant Professor of Pediatrics
Gibson J. Wells Assistant Professor of Pediatrics
William M. Seabold Assistant Professor of Pediatrics
Clewell Howell Associate in Pediatrics
G. Bowers Mansdorfer Associate in Pediatrics
Arnold F. Lavenstein Instructor in Pediatrics
Mary L. Hayleck Instructor in Pediatrics
Israel P. Meranski '. Instructor in Pediatrics
Melchijah Spragins Instructor in Pediatrics
Thomas A. Christensen Instructor in Pediatrics
Joseph M. Cordi Instructor in Pediatrics
William Earl Weeks Assistant in Pediatrics
J. Carlton Wich Assistant in Pediatrics
O. Walter Spurrler Assistant in Pediatrics
Lestek Caplan Assistant in Pediatrics
A. Maynard Bacon, Jr Assistant in Pediatrics
Sara Cook Assistant in Pediatrics
Ruth Baldwin Assistant in Pediatrics
A. Maynard Bacon, Jr.6 Assistant in Pediatrics
SCHOOL OF MEDICINE 81
Melvin N. Borden Assistant in Pediatrics
Howard Goodman Assistant in Pediatrics
Richard A. Young Research Assistant in Pediatrics
Margaret Lucille Ward Research Assistant in Pediatrics
Third Year. The course is presented as follows:
Lectures on infant feeding and the fundamentals of diseases of infants and
children. (15 hours.)
Lectures on contagious diseases in conjunction with the Department of
Hygiene and Preventive Medicine. (14 hours.)
A special course in physical diagnosis is given at City Hospitals. (20 hours.)
Clinical conferences demonstrating diseases of the new-born. (6 hours.)
Fourth Year. A clinic in the amphitheatre is given at which time patients are
shown demonstrating the features of the diseases discussed. (30 hours.)
Conferences and demonstrations are given in problems of diagnosis, care, treat-
ment and clinical pathology of diseases of infants and children. (30 hours.)
Students are assigned subjects on which to prepare theses.
Clinical clerkships are assigned on the pediatric wards, where experience is
gained in taking histories, making physical examinations, doing routine laboratory
work, and following up patients' progress. This is under the supervision of the
visiting staff. (140 hours.)
Instruction is given in the pediatric clinic of the out-patient department of
the University Hospital. This consists of 1J hours daily for five weeks — 30
minutes each day is devoted to a clinical demonstration of some interesting case
by a member of the staff; one hour daily to taking histories and making physical
examinations under the supervision of an instructor. (45 hours.)
Total hours: 300.
PHARMACOLOGY
John C. Krantz, Jr Professor of Pharmacology and Head of the Department
C. Jelleff Carr Professor of Pharmacology
Raymond M. Burgison Assistant Professor of Pharmacology
Ruth Musser Instructor in Pharmacology
Joseph G. Bird Assistant in Pharmacology
Amedeo S. Marrazzi Lecturer in Pharmacology
William G. Harne Demonstrator in Pharmacology
Frederick K. Bell Fellow in Pharmacology
Mary S. Fassel Emerson Fellow in Pharmacology
John B. Harmon Emerson Fellow in Pharmacology
Go Lu Fellow in Pharmacology
Leonard S. Brahen Eli Lilly Fellow in Pharmacology
Johnson S. L. Ling Eli Lilly Fellow in Pharmacology
This course is designed to include those phases of pharmacology necessary for
an intelligent use of drugs in the treatment of disease. The didactic instruction
includes materia medica, pharmacy, prescription-writing, toxicology, posology,
pharmacodynamics, and experimental therapeutics. The laboratory exercises
parallel the course of lectures.
82
UNIVERSITY OF MARYLAND
In addition, optional conference periods and lectures are available for students
desiring further instruction or advice.
Total hours: 216.
Graduate Courses. Consult the catalogue of the Graduate School for descrip-
tions of the graduate courses offered by members of the staff.
PHYSICAL DIAGNOSIS [a division of medicine]
T. Conrad Wolfe
Associate Professor of Medicine, and Head of the Division of Physical
Robert A. Reiter Assistant Professor of
Samuel Legum Associate in
Grafton Hersperger Associate
Edmund G. Beacham Associate
Louis Kroll Associate
Daniel Wilfson Associate
Leon Ashman Associate
Joseph Muse Instructor
Samuel Hankxn Instructor
John B. DeHoff Instructor
William G. Helfrich Instructor
Leon A. Kochman Instructor
Stuart D. Sunday Instructor
Elizabeth D. Sherrill Instructor
Stephen J. Van Lill, III Instructor
Franklin Leslie Assistant
Thomas Worsley Assistant
Lauriston Keown Assistant
Jack Wexler Assistant
Carl F. Myers Assistant
Bernard Burgin Assistant
Diagnosis
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
The course in physical diagnosis starts with the first semester of the Sophomore
year and ends with the termination of the second semester of the Junior year.
First Semester — Second Year — Lecture, one hour weekly covering the technique
of history writing and the mechanics of the physical signs elicited in the normal
person through inspection, palpation, percussion and auscultation.
Second Semester — Second Year — Lecture, one hour weekly, covering the tech-
nique of history writing in cases involving disease, and the mechanics of patho-
logical physical signs on inspection, palpation, percussion and auscultation.
In the third and fourth quarters small tutorial groups are formed, each under
the direction of an instructor. Experience in physical examination of normal indi-
viduals is given in the third quarter for one afternoon weekly. In the fourth
quarter the students become acquainted with abnormal signs through examination
of hospital patients.
Third Year — a. The class is divided into four sections. Each section receives
bedside instruction in physical diagnosis for seven weeks (2 hrs. daily). For this
purpose small groups under an instructor are formed. The instruction is carried
SCHOOL OF MEDICINE 83
on in the Baltimore City Hospitals but in addition advantage is occasionally taken
of the clinical opportunities in other institutions.
b. Lecture course (1 hr. weekly for 15 weeks) covering the mechanisms of ab-
normal signs.
PHYSIOLOGY
William R. Amberson Professor of Physiology and Head of the Department
Dietrich C. Smith Professor of Physiology
Frederick P. Ferguson Associate Professor of Physiology
J. McCullough Turner Associate Professor of Physiology
Harold E. Himwich Lecturer in Physiology
Samuel L. Fox Instructor in Physiology
Sylvia Hlmmelfarb Assistant in Physiology
Frances C. Brown Assistant in Physiology
Jeanne Ann Qulnlin Assistant in Physiology
John I. White U.S.P.H. Fellow in Physiology
Richard F. C. Egan John F. B. Weaver Fellow in Physiology
Annemarte Weber U.S.P.H. Research Fellow in Physiology
Carolyn F. Hendrickson Research Assistant in Physiology
The course in physiology is given in two parts:
First Year. Second Semester. Neuro-muscular physiology is presented in
two lectures a week, without laboratory work.
Second Year. First Semester. The remainder of the subject is presented in
four lectures, one conference, and two laboratory periods a week.
The fundamental concepts of physiology are presented with special reference
to mammalian problems.
Total hours: 224.
Graduate Courses. Consult the catalogue of the Graduate School for descrip-
tions of the graduate courses offered by members of the staff.
PLASTIC SURGERY [a division of surgery]
Edward A. Kitlowski Clinical Professor of Plastic Surgery
Clarence P. Scarborough Instructor in Plastic Surgery
Walter J. Benavent Assistant in Plastic Surgery
This course is designed to acquaint students with the problems of reconstruc-
tive and plastic surgery. A subdivision in the dispensary has been established
and beds for patients will be available for instruction in this course at the Univer-
sity and Baltimore City Hospitals and Kernan's Hospital for Crippled Children.
Third Year. Five lectures are given to the whole class. Dispensary instruction
is provided on Mondays and Fridays.
Fourth Year. Ward rounds and operative demonstrations are held at the
hospitals.
PROCTOLOGY [a division or surgery]
Monte Edwards Professor of Proctology
Thurston R. Adams Assistant Professor of Proctology
Simon H. Brager Assistant Professor of Proctology
84 UNIVERSITY OF MARYLAND
Donald B. Hebb Instructor in Proctology
William T. Supik Instructor in Proctology
Raymond M. Cunningham Instructor in Proctology
Third Year. Seven lectures are given to the whole class. The course is for
instruction in the diseases of the colon, sigmoid flexure, rectum and anus, and
covers the essential features of the anatomy and physiology of the large intestine
as well as the various diseases to which it is subject. Dr. Monte Edwards.
Fourth Year. Ward and dispensary instruction is given in the University and
Mercy Hospitals, where different phases of the various diseases are taught by
direct observation and examination. The use of the proctoscope and sigmoido-
scope in the examination of the rectum and sigmoid is made familiar to each stu-
dent. Mercy Hospital — Drs. Supik and Brager. University Hospital — Drs.
Monte Edwards and Adams.
Third year 7 hours
Fourth year 16 hours
Total 23 hours
PSYCHIATRY
Jacob E. Finesinger Professor of Psychiatry and Head of the Department
John R. Redd Visiting Professor of Psychiatry
H. Whitman Newell Associate Professor of Psychiatry
Harry M. Murdock Assistant Professor of Psychiatry
Philip S. Wagner Assistant Professor of Psychiatry
Hans W. Loewald Assistant Professor of Psychiatry
William W. Elgin Assistant Professor of Psychiatry
J. G. N. Cushing Assistant Professor of Psychiatry
Kathryn L. Schdltz Assistant Professor of Psychiatry
Robert G. Grenell Assistant Professor of Psychiatric Research
Isadore Tuerk Associate in Psychiatry
Ephralm T. Lisansky Associate in Psychiatry
Kathryn Dice Associate in Clinical Psychology
Elizabeth LaForge Associate in Psychiatric Social Work
Moritz Michaelis Research Associate in Biochemistry
Harold E. Himwich Lecturer in Psychiatry
A. Russell Anderson Instructor in Psychiatry
Francis J. McLaughlin Instructor in Psychiatry
Samuel Novey Instructor in Psychiatry
Marion W. Mathews Instructor in Psychiatry
Enoch Callaway, Jr Instructor in Psychiatry
William N. Fitzpatrick ' Assistant in Psychiatry
Gertrude Gross Assistant in Psychiatry
Marcella Weisman Assistant in Psychiatric Social Work
Vesta May Stevens Assistant in Psychiatric Social Work
Marjorie R. Fleitzer Assistant in Psychiatric Social Work
Hermione Hunt Hawkins Assistant in Clinical Psychology
Marvin Jaefe Fellow in Psychiatry
Virginia Suttonfield Fellow in Psychiatry
Ruth Page Edwards Fellow in Psychology
SCHOOL OF MEDICINE 85
Jeannette F. Rayner Research Assistant in Psychiatry
Betty J. Fax Research Assistant in Psychiatry
John Walker Powell Research Assistant in Psychiatry
Davtd Willenson Research Assistant in Psychiatry
Barbara Elizabeth Todd Research Assistant in Psychiatry
Carolyn Mae Miller Research Assistant in Psychiatry
First Year. Fourteen two-hour periods during the second semester are devoted
to a consideration of human relations as applied to the practice of medicine. The
topics dealt with include personality development, reactions to stress, and situ-
ational and social factors in disease. The emphasis is upon observing, under-
standing and evaluating the personal and social factors in the disease process, in
treatment and prevention. Consideration is given to problems of values and
scientific methodology as they apply to the work of the physician. Patients with
common medical and surgical complaints are interviewed to illustrate methods of
interviewing and developing a useful therapeutic relationship. The course is
conducted by means of group discussion, supplemented by reading.
Second Year. Fourteen two-hour periods are spent in the first semester in dis-
cussions and lectures. The emphasis is on methods of examining patients, and
methods of developing and utilizing the doctor-patient relationship. The dis-
cussions center about psychopathology, as it operates in disease and in the treat-
ment process. An attempt is made to relate emotional disturbances to what is
known in neurophysiology, endocrinology, psychology and sociology. Patients
are interviewed and examined to illustrate the general principles and the specific
procedures used in the examination of patients. The group discussions are supple-
mented by suggested reading.
Third Year. Sixteen lecture hours are devoted to further considerations of
special psychopathology and the principles of psychotherapy. Specialized forms
of treatment are reviewed, but the main emphasis is toward familiarizing the
student with forms of therapy feasible in routine medical practice. During 36
clinic hours the student will be supervised in history-taking, mental status and
psychometric examination, and follow-up studies of patients.
Fourth Year. A clinical clerkship is offered in the wards of the University
Hospital for one month. Patients are assigned for treatment under supervision.
Emphasis is placed on diagnosis, methods of interviewing, methods of developing
and managing a therapeutic doctor-patient relationship, and carrying out psycho-
therapy. This is supplemented by seminar meetings for discussion of child psy-
chiatry, psychotherapy, clinical psychology and social service. Topics are assigned
from the current literature for group discussion. Four afternoons are spent in
the wards of the Spring Grove State Mental Hospital in examining patients with
emphasis in the diagnosis, treatment and management of the psychoses. Eight
clinics are held for the entire fourth-year class.
ROENTGENOLOGY
Walter L. Ktlby Professor of Roentgenology, and Head of the Department
Charles N. Davidson Associate Professor of Roentgenology
John DeCarlo, Jr Assistant Professor of Roentgenology
86 UNIVERSITY OF MARYLAND
Donald J. Barnett Assistant Professor of Roentgenology
Edward R. Dana Associate in Roentgenology
John T. Brackin Instructor in Roentgenology
John M. Dennis Instructor in Roentgenology
Eugene R. McNlnch Fellow in Roentgenology
Robert VV. Swain Consultant in Radiologic Physics
During the academic year, small groups of the third and fourth year classes are
given weekly instruction in the diagnostic and therapeutic uses of the Roentgen
rays. An effort is made to familiarize the student with the indications for and the
limitations of the Roentgen ray examinations. The history, physics and practical
therapeutic application of Roentgen rays are given stressing the use of radiation
as a weapon now available in a variety of disorders of the human body ranging from
simple inflammations to malignant neoplastic conditions. Conferences are held
with the various departments during the school year which are also open to mem-
bers of the fourth year class.
Third year 8 hours
Fourth year 24 hours
Total 32 hours
SPEECH TRAINING CLINIC [a division of surgery]
Edward A. Kitlowski Clinical Professor of Plastic Surgery
Ray Ehrensberger Professor of Speech
Merle Ansberry Associate Professor of Speech
This department has been installed in conjunction with the Department of
Speech of the University at College Park to evaluate the speech difficulties in
children with congenital defects. Admission to the Clinic is by appointment only.
The Clinic operates all day Thursdays.
SURGERY
Charles Reid Edwards Professor of Surgery, and Acting Head of the Department
Walter D. Wise Professor of Surgery
Elliott H. Hutchtns Professor of Surgery
D. J. Pessagno Professor of Clinical Surgery
F. L. Jennings Professor of Clinical Surgery
George H. Yeager Professor of Clinical Surgery
Monte Edwards Clinical Professor of Surgery
Otto C. Brantigan Professor of Clinical Surgery
Harry C. Hull Professor of Clinical Surgery
James W. Nelson, M.D Professor of Clinical Surgery
R. Rkgeway Trimble Professor of Clinical Surgery
Charles A. Reifschneider Clinical Professor of Traumatic Surgery
Thomas R. Chambers Associate Professor of Surgery
R. W. Locher Associate Professor of Clinical Surgery
Edward S. Johnson Associate Professor of Surgery
Grant E. Ward Associate Professor of Surgery
Cyrus F. Hortne Associate Professor of Surgery
Charles W. Maxson Associate Professor of Surgery
SCHOOL OF MEDICINE 87
C. W. Peake Associate Professor of Surgery
William F. Reinhoff, Jr Associate Professor of Surgery
W. Wallace Walker Associate Professor of Surgery and Surgical Anatomy
H. F. Bongardt Assistant Professor of Surgery
I. O. Ridgely Assistant Professor of Surgery
Arthur G. Siwtnski Assistant Professor of Surgery
Simon H. Brager Assistant Professor of Surgery and Proctology
Thurston R. Adams Assistant Professor of Surgery
Raymond F. Helfrich Associate in Surgery
William B. Settle Associate in Surgery
George Govatos Associate in Surgery
Joseph V. Jerardi Associate in Surgery
Herbert E. Relfschneider Associate in Surgery
Harold H. Burns Associate in Surgery
William L. Garlick Associate in Surgery
Harry C. Bowie Associate in Surgery
Edward H. Stewart Associate in Surgery
Joseph M. Miller Lecturer in Surgery
J. Duer Moores Instructor in Surgery
Calvin Hyman Instructor in Surgery
Clyde F. Karns Instructor in Surgery
Daniel R. Robinson Instructor in Surgery
George H. Brouillet Instructor in Surgery
John F. Schaefer Instructor in Surgery
Robert F. Healy Instructor in Surgery
Robert C. Sheppard Instructor in Surgery
Samuel E. Proctor Instructor in Surgery
F. Ford Loker Instructor in Surgery
E. Roderick Shipley Instructor in Surgery
Patrick C. Phelan, Jr Instructor in Surgery
Louis E. Goodman Instructor in Surgery
William R. Geraghty Assistant in Surgery
Howard B. McElwain Assistant in Surgery
A. V. Buchness Assistant in Surgery
T. J. Touhey Assistant in Surgery
Samuel H. Culver Assistant in Surgery
L. T. Chance Assistant in Surgery
W. Allen Deckert Assistant in Surgery
William C. Dunnigan Assistant in Surgery
Howard L. Zupnik Assistant in Surgery
Raymond M. Cunningham Assistant in Surgery
John W. Chambers Assistant in Surgery
Ross Z. Plerpont Assistant in Surgery
Michael L. DeVincentis Assistant in Surgery
James N. Cianos Assistant in Surgery
Richard M. Garrett Assistant in Surgery
William D. Lynn Assistant in Surgery
R. Adam Cowley. . .Assistant in Thoracic Surgery; Assistant Director Surgical Research
Davtd R. Will Assistant in Surgery
Harold P. Blehl Assistant in Surgery
88 UNIVERSITY OF MARYLAND
Instruction is given by means of lectures, laboratory work, recitations, dis-
pensary work, bedside instruction, ward classes, and clinics. The work begins
in the second year and continues throughout the third and fourth years.
The teaching is done in the anatomical laboratory, operative surgery labora-
tory, the dispensaries, wards, laboratories and operating rooms of the University
and Mercy Hospitals, and in the wards and operating rooms of the Baltimore City
Hospitals.
SECOND YEAR
Topographic and Surgical Anatomy. Second semester. The course is
designed to bridge the gap between anatomy in the abstract and clinical anatomy
applied to the study and practice of medicine and surgery.
The teaching is done in the anatomical laboratory. Students are required to
dissect and to demonstrate all points, outlines, and regions on the cadaver. Under-
lying regions are dissected to bring out outlines and relations of structures.
Two lectures and two laboratory periods per week. Drs. Brantigan, Walker,
Settle, Bowie, H. E. Reif Schneider, Pierpont and Garrett.
Total hours: 96.
Principles of Surgery. Second semester. The course includes discussions
of irritants, infection, repair of tissue, healing of tissue, relationship of bacteriology
to surgery, modern chemotherapy in surgical diseases, ulcers, wounds, thrombo-
phlebitis, phlebothrombosis, peripheral vascular diseases, thermal burns, injuries
due to cold, surgical shock, diseases of the lymphatics, gangrene of the skin and
extremities, aneurysms, hemorrhage, varicose veins, embolism, sinuses and fistulae,
tetanus, anthrax and actinomycosis.
Lectures, two hours a week for one semester, are given to the whole class. Drs.
Adams and Sheppard.
THIRD YEAR
General and Regional Surgery. Lectures, recitations and clinics on the
principles of surgery, general surgery including fractures and dislocations are
given three hours a week to the whole class. Dr. Hull.
The class is divided into groups and receives instruction in history-taking
and surgical pathology under the supervision of the chief of the pathology
department of the Baltimore City Hospitals. Instruction is also given in surgi-
cal diagnosis and in general surgery at the bedside and in the classroom at this in-
stitution by Drs. Bowie, Koontz, Brantigan and Adams. Two hours per week
are given in orthopaedic surgery by Dr. Voshell, chief of the orthopaedic service
of this institution.
Operative Surgery. Lectures and operative demonstrations are given under
the supervision of Dr. Yeager assisted by Dr. Govatos. The class is divided into
sections and each section is given practical and individual work under the super-
vision of instructors.
Surgical Out-patient Department. Under supervision, the student takes
the history, makes the physical examination, attempts the diagnosis and, as far
as possible, carries out the treatment of ambulatory surgical patients in the
University and Mercy Hospitals. Mercy Hospital — Dr. Raymond F. Helfrich
SCHOOL OF MEDICINE 89
assisted by the out-patient staff. University Hospital — Drs. Settle and Sheppard
assisted by the out-patient staff.
FOURTH YEAR
Clinics. Surgical pathological Conference. A weekly conference is conducted
at the University Hospital for the entire class. Daily ward classes at University
and Mercy Hospitals, and half day ward work under the supervision of Dr. E. R.
Shipley at University and Dr. F. Ford Loker, Mercy Hospital.
Surgery or the Chest: — Mercy Hospital. Operations and conferences. 14
hours. Drs. Rienhoff and Garlick.
Traumatic Surgery. This course deals with operative and post-operative
treatment of accident cases and with instructions as to the relationship between the
state, the employee, the employer, and the physician's duty to each. One hour
a week to sections of the class throughout the year. Dr. C A. Reifschneider.
Clinical Clerkship. This work includes the personal study of assigned
hospital patients under supervision of the staffs of the University and Mercy
Hospitals, and embraces history-taking, and physical examination of patients,
laboratory examinations, attendance at operations and observation of post-
operative treatment.
Ward Classes. Ward-class instruction in small groups will consist of ward
rounds, surgical diagnosis, treatment and the after-care of operative cases. Mercy
Hospital — Drs. Wise, Hutchins, Pessagno, Nelson, Trimble, Brager, Jerardi, Gar-
lick and Loker. University Hospital — Drs. C. Reid Edwards, Yeager, Hull and
C. A. Reifschneider.
THORACIC SURGERY [a division of surgery]
Otto C. Brantigan Professor of Thoracic Surgery
William L. Garlick Associate Professor of Thoracic Surgery
Donald B. Hebb Assistant in Thoracic Surgery
R. Adams Cowley Assistant in Thoracic Surgery
Sim Penton Resident in Thoracic Surgery
Frank Faraino Fellow in Thoracic Surgery
Men having completed three years of American Board of Surgery training are
eligible for appointment. The first year is spent in thoracic research surgery. The
second year is in clinical thoracic surgery at Baltimore City, Mercy and Univer-
sity Hospitals.
TROPICAL MEDICINE [a division of medicine!
Certain phases of tropical medicine are considered in the course on clinical
pathology. In addition, a course of lectures and demonstrations is given to the
entire fourth year class.
TUBERCULOSIS [a division of medicine]
During the third year in connection with the instruction in physical diagnosis
a practical course is given at the Municipal Tuberculosis Hospital. Stress is laid
upon the recognition of the physical signs of the disease, as well as upon its sympto-
matology and gross pathology.
90 UNIVERSITY OF MARYLAND
UROLOGY [a division of surgery]
W. Houston Toulson Professor of Urology
Kenneth D. Legge Professor of Clinical Urology
Howard B. Mays Assistant Professor of Urology
Francis W. Gillis Assistant Professor of Urology
John F. Hogan Assistant Professor of Urology
Austin H. Wood Associate in Urology
Lyle J. Millan Associate in Urology
L. K. Fargo Associate in Urology
Hugh J. Jewett Associate in Urology
John S. Haines Associate in Urology
Martin A. Robbins Instructor in Urology
John D. Young, Jr Instructor in Urology
Charles W. Hawkins Assistant in Urology
Morris A. Fine Assistant in Urology
Henry K. Jarrett Assistant in Urology
Third Year. This course is given for seven hours to the whole class. It con-
sists of lectures and demonstrations, including the use of lantern slides and motion
pictures. Dr. Toulson.
Fourth Year. The course includes explanations and demonstrations of urethros-
copy, cystoscopy, ureteral catheterization, renal function tests, urography, urine
cultures and the various laboratory procedures. The teaching consists of clinics
and ward rounds to small groups, and attendance by members of the senior class
upon the out-patients in the dispensary. The student is placed on his own re-
sponsibility in arriving at a diagnosis. These dispensary classes are conducted
at both the Mercy and University Hospitals where practically every variety of uro-
genital disease is seen and used for teaching purposes.
Third year 6 hours
Fourth year 39 hours
Total 45 hours
MEDICAL LIBRARY
Howard Rovelstad, A.B., M.A., B.S.L.S Director of Libraries and Professor
of Library Science
Ida Marian Robinson, A.B., B.S.L.S Librarian and Associate Professor of
Library Science
Hilda E. Moore, A.B., A.B.L.S Assistant Librarian
Florence R. Klrk Assistant Librarian
Marie Harvin, B.A., B.S.L.S Cataloguer
Charlotte Wilson Assistant to the Cataloguer
Jane Spacek Secretary to the Librarian
POSTGRADUATE COURSES
Committee on Postgraduate Studies
Howard M. Bubert, Chairman and Director
SCHOOL OF MEDICINE 91
Dietrich C. Smith, 1st Vice-chairman Frank H. J. Figge
L. A. M. Krause, 2nd Vice-chairman Wetherbee Fort
Milton S. Sacks, Secretary John C. Krantz, Jr.
J. Edmund Bradley J. Morris Reese
Otto C. Brantigan Allen F. Voshell
John A. Wagner
Elizabeth Carroll, Executive Secretary
The Dean — Ex Officio
Calendar: Postgraduate courses are offered throughout the year.
During the past year, the Post Graduate Committee has given an extramural
course in Hagerstown. Enrollment was 25. The Committee will consider the
request of any Maryland County Medical Society for a series of lectures to begin
in the Fall of 1951.
A sub-committee appointed to survey the hospitals in the State which desire
assistance in the training of house staffs has been working actively during the year,
and progress has been made.
The Basic Science course in OB-GYN has been withdrawn temporarily.
The following intramural postgraduate courses have been continued.
General Anatomy: The course is designed to prepare candidates for the ex-
amination of the American Board of General Surgery and Surgical Specialties.
There is no strict rule governing either the content or duration of the course.
Students may dissect a complete cadaver or any particular region in which they
may be interested. Tuition arranged according to course content and duration.
Anatomy of Head and Neck as applied to the eye, ear, nose and throat.
Duration 150 hours, beginning on October 1 and ending approximately February
28, comprising two periods of 4 hours per week. Tuition $75.00. Details as
to the time of the individual periods will be arranged with candidates who wish to
take the course.
Surgical Anatomy: The course is designed to prepare candidates for the ex-
amination in Anatomy of the American Board of Surgery. This is a ninety-hour
course (3 hours a day, 2 days a week) given in conjunction with the regular sopho-
more medical course in surgical anatomy. Tuition $150.00.
Pathology: This course is designed to prepare candidates for certification in
surgery, surgical specialties and internal medicine. Individuals will receive train-
ing in autopsy and surgical pathology. Minimum duration is full time, six months.
Tuition $150.00.
Neuro-pathology: This course is designed to aid in meeting the requirements of
the specialty boards in neurological sciences and covers basic studies in diseases
of the central nervous system. Duration is six months, full time. Tuition
$200.00 plus $10.00 laboratory fee.
Gynecology and Obstetrics: This is a review for general practitioners.
Students attend lectures, ward rounds and clinics, and observe operations and
deliveries. Full time for twelve weeks. Tuition $150.00.
92
UNIVERSITY OF MARYLAND
Gynecology, Oncology and Female Urology: This is a review designed
primarily for the general practitioner. Students attend lectures, ward rounds
and clinics and observe operations. Full time for ten weeks. Tuition $125.00.
Basic Sciences as They Apply to the Practice of Medicine. This course
is designed to familiarize students with the advances in basic sciences during recent
years. The course consists of 32 periods of 2 hours each, once a week between
October and June. Tuition $50.00.
Full descriptions of these courses are available. Inquiries should be addressed
to the Post Graduate Committee, University of Maryland School of Medicine,
Baltimore 1, Maryland.
LECTURERS IN POSTGRADUATE MEDICINE
Thurston R. Adams
Marie A. Andersch
James G. Arnold, Jr.
Robert E. Bauer
Joseph G. Bird
Harry C. Bowie
J. Edmund Bradley
Otto C. Brantigan
George H. Brouillet
Howard M. Bubert
T. Nelson Carey
C. Jelleff Carr
Robert Chenowith
Ernest I. Cornbrooks, Jr.
Edward F. Cotter
Richard J. Cross, Jr.
Francis G. Dickey
William K. Diehl
Everett S. Diggs
D. McClelland Dixon
Louis H. Douglass
John C. Dumler
J. Sheldon Eastland
Charles Reid Edwards
William L. Fearing
Frank H. J. Figge
Jacob E. Finesinger
A. H. Finkelstein
Russel S. Fisher
Albert E. Goldstein
Lewis P. Gundry
Frank W. Hachtel
Jerome Hartz
Charles W. Hawkins
Nathan B. Herman
Harry C. Hull
J. Mason Hundley, Jr.
D. Frank Kaltreider
Theodore Kardash
Vernon E. Krahl
John C. Krantz, Jr.
L. A. M. Krause
Arnold F. Lavenstein
C. Edward Leach
Ephraim T. Lisansky
William S. Love, Jr.
Wm. V. Lovitt, Jr.
Fred R. McCrumb
Hugh B. McNally
Howard B. Mays
Samuel Morrison
H. Whitman Newell
Frank J. Otenasek
Robert T. Parker
Ross Z. Pierpont
Maurice C. Pincoffs
J. Morris Reese
Herbert E. Reifschneider
Dexter L. Reimann
Henry L. Rigdon
Harry M. Robinson, Sr.
Raymond C. V. Robinson
Milton S. Sacks
John E. Savage
Sidney Scherlis
Emil G. Schmidt
William B. Settle
Dietrich C. Smith
Hugh R. Spencer
Melchijah Spragins
Edwin H. Stewart, Jr.
Harry A. Teitelbaum
W. Houston Toulson
Eduard Uhlenhuth
Henry F. Ullrich
Allen Fiske Voshell
John A. Wagner
Wallace Walker
Milton J. Wilder
Walter D. Wise
Henry L. Wollenweber
Theodore E. Woodward
Robert B. Wright
George H. Yeager
FIRST YEAR SCHEDULE
FIRST SEMESTER, SEPTEMBER 20, 1951 TO JANUARY 26, 1952
Hours
9.00
to
12.00
12.00
to
1.00
1.00
to
5.00
Monday
Tuesday
•Histology and
Embryology
Lecture and Lab.
2nd Floor Bressler
Wednesday
Orientation
9:00-10:00
1st 3 Lectures
A.H.
Anatomy
10:00-12:00
1st 3 Sessions
After Oct. 10
Anatomy
9:00-12:00
lsl Floor Br. Lab.
Thursday
Friday
•Histology and
Embryology
Lecture and Lab.
2nd Flout Bressler
Lunch
Gross Anatomy
Lectures A. E. (1-2) Daily and Laboratories Bressler 1 (2-5) Daily
Saturday
Gross Anatomy
A.E.
' Course ends December 21, 1951.
SECOND SEMESTER, JANUARY 28 TO JUNE 7, 1952
Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
9.00
to
12.00
Laboratory
Biol. Chem.
Sect. A
Laboratory
Biol. Chem.
Sect. B
Laboratory
Biol. Chem.
Sect. A
Laboratory
Biol. Chem.
Sect. B
12.00
to
1.00
Lunch
Lunch
Lunch
Lunch
Lunch
1.00
to
2.00
Biol. Chem.
Aim. 1
Biol. Chem.
Aim. 1
Biol. Chem.
A dm. 1
Biol. Chem.
Adm. 1
Biol. Chem.
Adm. 1
2.00
to
3.00
Psychiatry
2-4
Amp.
Univ. Hosp.
Neuro-
Anatomy
Lecture
and
Laboratory
Bressler
2nd Floor
Biol. Chem.
Conference
Adm. 1
Neuro-
Anatomy
Lecture
and
Laboratory
Bressler
2nd Floor
Biol. Chem.
Conference
Adm.l
3.00
to
5.00
Neuro-
physiology
4-5
Bressler 2
Neuro-
physiology
Bressler 2
(3-4)
Locations of Lecture Halls and Laboratories:
Adm. 1— First Floor, Administration Building, 520 W. Lombard Street.
A. H.— Anatomical Hall— Upper Hall, N. E. Cor. Lombard and Greene Streets.
C. H.— Chemical Hall, Lower Hall, 522 W. Lombard Street.
Biological Chemistry Laboratory— Third Floor, 31 South Greene Street.
Bressler Research Laboratory— 29 S. Greene Street.
Gross Anatomy— First Floor.
Histology and Embryology— Second Floor.
Neuro-anatomy— Second Floor .
Mid-Year Examinations— January 21-26, 1952
Final Examinations— Begin May 26, 1952
93
SECOND YEAR SCHEDULE
FIRST SEMESTER, SEPTEMBER 20, 1951 TO JANUARY 26, 1952
Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
8.30
9.30
Physiology
Bressler 2
Physiology
Bressler 2
Medicine
Bressler Z
Physiology
Bressler 2
Physiology
Bressler Z
9.30
to
10.30
Physiology
Conference
Bressler 2
Bacteriology
Aim. 1
Bacteriology
Adm. 1
Pharmacology
Bressler Z
Pharmacology
Bressler Z
10.30
to
12.30
tBacteriology
Laboratory
Neurological
Diagnosis
10:45-11:45
C.H.
12.30
Lunch
1.00
Pharmacology Lecture
Bressler 2
Sect. B. | Sect. A.
1:00-2:00
Psychiatry
1:30-3:30
C.H.
Pharmacology Laboratory
3rd Floor Bressler
Sect. B. | Sect. A.
1:00-4:00
to
5.00
Physiology Laboratory
4th Floor Bressler
Seel. A. | Sect. B.
1:00-5:00
Physiology Laboratory
4th Floor Bressler
Sect. A. | Sect. B.
1:00-5:00
t Bacteriology Laboratory — Section work during the last month.
SECOND SEMESTER, JANUARY 28 TO JUNE 7, 1952
Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
8.30
to
9.30
Surgery
Bressler Z
Surgery
Bressler Z
Surgical
Anatomy
Adm. 1
Medical Clinic
Amp.
Dispensary
Building
Physical
Diagnosis
Adm. 1
Orthopaedics
Bressler 2
9.30
to
10.30
Pharmacology
Bressler Z
Pharmacology
Bressler Z
Surgical
Anatomy
Laboratory
Bressler 1
Pharmacology
Bressler 2
Obstetrics
Bressler Z
10.30
to
11.30
Pathology
C. H.
Pathology
C.H.
Pathology
Adm. 1
Pathology
C.H.
11.30
Lunch
12.00
to
2.00
Pathology
Laboratory
Pathology
Laboratory
Immunology
Laboratory
Pathology
Laboratory
Pathology
Laboratory
2.00
to
3.00
Surgical
Anatomy
Adm. 1
!! Immunology
Laboratory
Pharmacology
Laboratory
Sect. A
Physical
Diagnosis
Sect. B
(3:00-5:00)
U.H.D.
Pharmacology
Laboratory
Sect. B
Physical
Diagnosis
Sect. A
(3:00-5:00)
U.H.D.
3.00
to
5.00
Surgical
Anatomy
Laboratory
Bressler I
Optional period
Pathology
Immunology
|j Immunology Laboratory — Section work during last two months.
Locations of Lecture Halls and Laboratories:
Adm. 1— First Floor, Administration Building, 520 W. Lombard Street.
C. H.— Chemical Hall, Lower Hall, 522 W. Lombard Street.
Amp.— Wilson Memorial Amphitheatre, New University Hospital, Greene and Redwood Streets, Eighth Floor.
U. H. D.— University Hospital Dispensary, Old Hospital Building.
Laboratories:
Physiology, Pharmacology, Surgical Anatomy— Bressler Building.
Bacteriology, Immunology, Pathology, Second Floor, 31 S. Greene Street.
Mid-Year Examinations — January 21-26, 1952
Final Examinations— Begin May 26, 1952
94
SCHOOL OF MEDICINE
95
THIRD YEAR SCHEDULE
SEPTEMBER 20, 1951 TO JUNE 7, 1952
SCHEDULE 1
Hoars
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
(Whole Class)
(Whole Class)
(Whole Class)
(Whole Class)
(Whole Class)
(Whole Class)
1.30
to
Obstetrics
Surgery
Obstetrics
Surgery
Pathology
Surgery
C.H.
C.H.
C.H.
C.H.
C.H.
C.H.
tGynecology
tGynecology
t Anaes thesiology
March 31 to
Mar. 26 to
Mar. IS to May 17
May 12
May 14
Amp.
9.30
to
Transfer to Baltimore City Hospitals
10.00
10.00
to
12.00
Physical Diagnos
is, Pathology, Pediatrics and Neurology at B. C. H.
(See Group Schedules)
12.00
Transfer
Transfer
Transfer
to
and
and
Lunch
and
Lunch
1.00
Lunch
Lunch
Lunch
(Whole Class)
•Gynecology
(Whole Class)
(Whole Class)
tEye— 10 wks.
Medical
Nose & Throat,
Jan. 29 to
Clinical
Obstetrics
1.00
Urology ,
Apr. 1
to
Otology,
tOncology
Clinic
Pathology
2.00
Proctology,
Plastic Surgery
C.H.
— 5 wks.
Apr. 8 to
May 6
C.H.
B. C. H.
Bressler Z
B. C. H.
Surgery
(Whole Class)
(2-3)
B. C. B.
2.00
(Whole
Class)
Pathology '.
3
Surgery
Clinical
4.00
t
Orthopaedics
Pathology
(3-4)
B. C. B.
(Whole Class)
4.00
J Legal Medicine
(Whole Class)
Hygiene and
Public Health
Orthopaedics
Laboratory
Neuro-Surgery
to
§ Industrial
Roentgenology
5.00
Medicine
II Psychiatry
C.H.
C.H.
B. C. H.
Bressler 5
B. C. B.
First Semester. t Second Semester. % Sept. 24 to Dec. 10. § Dec. 17 to Feb. 11. || Feb. 18 to May 12
SCHEDULE 2
Hoars
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
(Whole Class)
(Whole Class)
(Whole Class)
(Whole Class)
(Whole Class)
(Whole Class)
8.30
Obstetrics
Surgery
Obstetrics
Surgery
Pathology
Surgery
C.H.
C.H.
C.H.
C.H.
C.H.
CH.
9.20
tGyn ecology
March 31 to
May 12
tGyn ecology
Mar. 26 to
May 14
Anaesthesiology
Mar. 15toMayl7
Amp.
9.30
Medicine
Medicine
Therapeutics
Medicine
to
C.H.
t Pediatrics
t Pediatrics
t Pediatrics
t Pediatrics
Neurology
10.20
C.H.
C.H.
C. H.
C.H.
C. H.
10.30
Operative Surgery — Bressler 6
to
12.30
Medical and Surgical Dispensaries
— (Univ. and Mercy Sections)
12.30
to
Lunch
1.00
1.00
Medical
2.00
Clinic
Sam
: as
Amp.
Same as
Psychiatry
Dermatology
2.00
Ophthalmoscopy
*• (S weeks)
to
Sche<
ule 1
B. E. H.
Schedule 1
U. H. Disp
1-4
4.00
Obstetrics
*» (5 weeks)
U. H. Disp.
Otology
** (5 weeks)
4.00
Obstetrics
5.00
Univ. Hosp.
3-C
C. H.
The Junior Class will be divided into two sections — A and B. Each section reports to classes in keeping with the
following schedule assignment, in which the letters represent the class sections and the numerals indicate the schedules to
be followed for the periods shown.
J Pediatrics given the last week in each semester.
Schedule Assignment
Semester Periods:
September 20, 1951 to January 26, 1952
January 28 to May 17, 1952
•* 5-week periods:
First Semester Second Semester
Sept. 20-OcL 24 Jan. 28-Mar. 4
Oct 25-Dec. 4 Mar. 5-Apr. 8
Dec. 5-Jan. 19 Apr. 9-May 17
Locations of Lecture Halls, etc.
A dm. 1. — First Floor, Administration Building, 520 W. Lombard Street.
A. H— Anatomical Hall, Upper Hall, 522 W. Lombard Street.
Amp. — Wilson Memorial Amphitheatre, New University Hospital, Eighth Floor.
B. C. H— Baltimore City Hosps., 4940 Eastern Ave.
B. E. H— Baltimore Eye, Ear and Throat Hospital, 1214 Eutaw Place.
Bressler — Bressler Building, 29 S. Greene Street.
C. H.— Chemical Hall, Lower Hall, 522 W. Lombard Street.
Univ. Hosp. — New University Hospital, Greene and Redwood Streets.
U. H. Disp. — Old Hospital Building, S. W. Cor. Lombard and Greene Streets.
31 — 31 South Greene Street.
Clinical Pathology Laboratory — Fifth Floor, Bressler Building.
Pathology Laboratory— 31 South Greene Street, Special Rooms, Basement.
Mid-Year Examinations — January 21-26, 1952
Final Examinations — Begin May 19, 1952
96
Sections and Schedules
A-l, B-2
B-l, A-2
SCHOOL OF MEDICINE
97
FOURTH YEAR SCHEDULE
SEPTEMBER 20, 1951 TO MAY 24, 1952
CLASS DIVISIONS*
Division If
Division 2
Division 3f
Division 4
Medicine and Medical
Pediatrics
Surgery and Surgical
Obstetrics
Specialties (8 weeks)
(4 weeks)
Specialties (8 weeks)
(2 weeks)
Neurology
Psychiatry
Urology
Gynecology
Cardiology
(4 weeks)
Neuro Surgery
Oncology
Gastro-Enterology
Otology, Rhinology and
(2 weeks)
Metabolism
Laryngology
—
Allergy
Orthopaedics
Dermatology & Syphilology
—
—
Oncology
Roentgenology
Roentgenology
Ophthalmology
Anesthesiology
(4 weeks)
STUDENT GROUP ASSIGNMENTS
1st Quarter
3rd Quarter
Sept. 20, 1951 to Nov. 15, 1951
(8 weeks)
Groups 1, 2, 3, 4 to Division If
Groups 5, 6, 7, 8 to Division 2
Groups 9, 10, 11, 12 to Division 3f
Groups 13, 14, 15, 16 to Division 4
Jan. 28, 1952 to March 26, 1952
(8 weeks)
Groups 1, 2, 3, 4 to Division 3f
Groups 5, 6, 7, 8 to Division 4
Groups 9, 10, 11, 12 to Division It
Groups 13, 14, 15, 16, to Division 2
2nd Quarter
4th Quarter
Nov. 16, 1951 to Jan. 26, 1952
(8 weeks)
Groups 1, 2, 3, 4 to Division 2
Groups 5, 6, 7, 8 to Division 3f
Groups 9, 10, 11, 12 to Division 4
Groups 13, 14, 15, 16 to Division It
March 27, 1952 to May 24, 1952
(8 weeks)
Groups 1, 2, 3, 4 to Division 4
Groups 5, 6, 7, 8 to Division It
Groups 9, 10, 11, 12 to Division 2
Groups 13, 14, 15, 16 to Division 3t
•The curriculum is arranged into 4 divisions, and the senior class into 16 groups.
t The curriculum of Divisions 1 and 3 is given at the University and Mercy Hospitals simultaneously. There are
4 groups assigned to each division. Two groups or one half the students of each division are assigned work for 4
weeks at each hospital. Students belonging to groups 1, 2, 9 and 10 report to the University Hospital for the 1st 4
weeks. Groups 3, 4, 11 and 12 report to Mercy. At the end of 4 weeks the students at the University Hospital re-
port to Mercy and the groups at Mercy report to the University Hospital for a similar period, thus completing for each
group involved one division of work.
98
UNIVERSITY OF MARYLAND
UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE
AND COLLEGE OF PHYSICIANS AND SURGEONS
GRADUATES, JUNE 9, 1951
Agee, Law Lamar, B.S Alabama
Arthur, Robert Key, Jr., B.S. . . Georgia
Barthel, John Paul Maryland
Beardsley, Earl Miller Maryland
Bell, Arthur Keith, B.A Maryland
Bilder, Joseph, Jr., B.S Ohio
BrRELY, Beverly Robert Maryland
Blades, Nancy, B.A New Jersey
Bossard, John Wesley, B.A. . Maryland
Brannon, John Vandale, B.S.
West Virginia
Buell, John Russell, Jr Maryland
Christopher, Russell Lee, B.A.
Massachusetts
Clemmens, Raymond Leopold, B.S.
Maryland
Coffman, Kaohlin Miner, B.A.
Pennsylvania
Cohen, Solomon, B.A Maryland
Curanzy, Raymond Ralph, B.S.
Pennsylvania
Deckelbaum, Joseph, B.S Maryland
Dettbarn, Ernest Albert, B.S.
Maryland
Donner, Leon, B.S Maryland
Dudley, Winston Clark, B.A.
Massachusetts
Dunn, George Mitchell, Jr.
Washington, D. C.
Dunnagan, William Andrew, B.A.
North Carolina
Edwards, David Everett . Pennsylvania
Edwards, William Hunter, Jr., B.A.
Maryland
Esmond, William George, B.S. . Maryland
Evans, Otis Druell, Jr., B.S.
North Carolina
Ferguson, Charles Kirkpatrick
Colorado
Fitzgerald, Joseph Carroll, B.A.
Maryland
Fullilove, Rowland Elder Jack
Georgia
Gallagher, James Patrick, B.A.
West Virginia
Garcia Palmteri, Mario Ruben, B.S.
Puerto Rico
Gardner, Francis Sdoney, Jr., B.A.
North Carolina
Gates, John Butler Wisconsin
Gordon, Benjamin Dichter, B.A.
New York
Hatem, Frederick Joseph, B.S.
Maryland
Hopkins, Robert Charles, B.S.
Pennsylvania
Iten, George Joseph, B.A California
Johnson, Frederick Miller, B.S., M.S.
Maryland
Johnson, Wallace Edward
New Hampshire
Kaschel, Paul Edward, B.A. . New Jersey
Kindt, Willard Freed Pennsylvania
KrNG, Victor Francis Maryland
Ktpnis, Davdd Morris, B.A., M.A.
Maryland
Knd?p, Harry Lester Maryland
Kramer, Howard Calvin Maryland
Lamb, William Eugene, B.S Florida
Lanntng, Theodore Reuney, B.S.
New Jersey
Leibman, Jack, B.A Maryland
Ley, Leo Henry, Jr Maryland
Lister, Leonard Melvin Maryland
MacDonald, James Melvin, Jr., B.S.
Maryland
McFadden, Earl Boyd, B.S. . . . Maryland
McFadden, John William, B.S.
Maryland
McGrady, Charles Winfred, Jr., B.S.
Georgia
McGrady, Kathleen Reilly, B.S.
New York
Mendez Bryan, Ricardo Tomas, B.S.
Puerto Rico
Metcalf, John Shelby, Jr. . . . California
Mosser, Robert Schaaf, B.S.. .Maryland
Mutter, Arthur Zelig, B.S Maryland
Myers, Donald Johnson, B.S Ohio
Nygren, Edward Joseph, B.A.. Maryland
Orth, John Stambaugh Maryland
Packard, Douglas Richards . . Maryland
Pencheff, Dorris Marie, B.A. . California
Perilla, Frank Robert, B.S.. .Maryland
Perry, Henry David, Jr., B.A. . . Florida
Reeser, Guy McClelland, Jr., B.A.
Maryland
Reeves, Henry Gray, Jr.
North Carolina
Rex, Eugene Braiden Colorado
Reynolds, Georgia, B.A Maryland
Richardson, Aubrey DeVaughn, B.S.
North Carolina
Rombro, Marvin Jay, B.A Maryland
Rowland, Harry Shepard, Jr., B.A.
New Jersey
Saavedra Amador, Armando, B.S.
Puerto Rico
Schmale, Arthur Henry, Jr.. .Nebraska
Scott, Roger David Florida
Scully, John Thorsen Indiana
Shea, William Harold Holland. B.S.
Maryland
Sherry, Samuel Norman, B.S. . Maryland
SCHOOL OF MEDICINE 99
Simmons, Leslie Dale, B.S. Venrose, Robert James, B.A Ohio
West Virginia Watson, Charles Polk, Jr., B.A.
Sipple, Edward M., B.A Maryland West Virginia
Skipton, Roy Kennedy, B.S. ... Maryland Weekley, Robert Dean, B.S Ohio
Solomon, David Milton Maryland Wheelwright, Harvey Pearse Utah
Stone, John Hopkins, B.S Maryland Williams, Charles Ray, B.A.
Sutton, Julian Theoplous B.A. y Shelley c Pennsylvania
„ North Carolina North Carolina
Tobias, Richard Boyd, B.S. . Pennsylvania York, Thomas Luther, B.A.
Twigg, Homer Lee, Jr Maryland North Carolina
Udel, Melvln, B.A Maryland Young, Calvin Lessey, B.S. . . . Maryland
HONORS
University Prize Gold Medal
David Morris Kd?nis
Certificate op Honor
Leonard Melvin Lister Leon Donner
Frank Robert Perilla Douglas Richards Packard
William George Esmond
The Dr. A. Bradley Gaither Memorial Prize
Leonard Melvin Lister
The William D. Wolfe Memorial Prize and Certificate of
Proficiency
Charles Polk Watson, Jr.
INTERNSHIPS— GRADUATES OF JUNE 9, 1951
July 1, 1951-June 30, 1952
Ager, Law Lamar Jefferson Hillman Hospital, Birmingham, Ala.
Arthur, Robert Key, Jr Jefferson Hillman Hospital, Birmingham, Ala.
Barthel, John Paul St. Luke's Methodist Hospital, Cedar Rapids, Iowa
Beardsley, Earl Miller U. S. Naval Hospital, San Diego, Cal.
Bell, Arthur Keith The Toledo Hospital, Toledo, Ohio
Bilder, Joseph, Jr The City Hospital of Akron, Akron, Ohio
Birley, Beverly Robert Union Memorial Hospital, Baltimore, Maryland
Blades, Nancy The Christ Hospital, Cincinnati, Ohio
Bossard, John Wesley University Hospital, Baltimore, Md.
Brannon, John Vandale U. S. Naval Hospital, San Diego, Cal.
Buell, John Russell, Jr Mercy Hospital, Baltimore, Md.
Christopher, Russell Lee Harrisburg Polyclinic Hospital, Harrisburg, Pa.
Clemmens, Raymond Leopold Mercy Hospital, Baltimore, Md.
Coffman, Kaohlln Miner The Williamsport Hospital, Williamsport, Pa.
Cohen, Solomon Sinai Hospital, Baltimore, Md.
Curanzy, Raymond Ralph Reading Hospital, Reading, Pa.
Deckelbaum, Joseph Sinai Hospital, Baltimore, Md.
Dettbarn, Ernest Albert Lutheran Hospital of Maryland, Inc., Baltimore, Md.
Donner, Leon Sinai Hospital, Baltimore, Md.
100 UNIVERSITY OF MARYLAND
Dudley, Winston Clark Baltimore City Hospitals, Baltimore, Md.
Dunn, George Mitchell, Jr University Hospital, Baltimore, Md.
Dunnagan, William Andrew U. S. Marine Hospital, Detroit, Mich.
Edwards, David Everett U. S. Marine Hospital, Norfolk, Va.
Edwards, William Hunter, Jr Union Memorial Hospital, Baltimore, Md.
Esmond, William George Lutheran Hospital of Maryland, Inc., Baltimore, Md.
Evans, Otis Druell, Jr.
University of Texas Medical Branch Hospitals, Galveston, Texas
Ferguson, Charles Kirkpatrick Bethesda Hospital, Cincinnati, Ohio
Fitzgerald, Joseph Carroll University Hospital, Baltimore, Md.
Fullilove, Rowland Elder Jack Church Home and Hospital, Baltimore, Md.
Gallaher, James Patrick The Reading Hospital, Reading, Pa.
Garcia Palmteri, Mario Ruben Fajardo District Hospital, Fajardo, Puerto Rico
Gardner, Francis Sidney, Jr City of Detroit Receiving Hospital, Detroit, Mich.
Gates, John Butler Mercy Hospital, San Diego, Cal.
Gordon, Benjamin Dichter King County Hospital, Brooklyn, N. Y.
Hatem, Frederick Joseph U. S. Naval Hospital, Staten Island, N. Y.
Hopkins, Robert Charles St. Vincent's Hospital, Erie, Pa.
Iten, George Joseph St. Agnus Hospital, Baltimore, Md.
Johnson, Frederick Miller Baltimore City Hospitals, Baltimore, Md.
Johnson, Wallace Edward St. Francis Hospital, Hartford, Conn.
Kaschel, Paul Edward Baltimore City Hospitals, Baltimore, Md.
Kindt, Willard Freed Allentown General Hospital, Allentown, Pa.
King, Victor Francis St. Agnes Hospital, Baltimore, Md.
KrpNis, Davdd Morris The Johns Hopkins Hospital, Baltimore, Md.
Knipp, Harry Lester St. Agnes Hospital, Baltimore, Md.
Kramer, Howard Calvin Mercy Hospital, Baltimore, Md.
Lamb, William Eugene Gallinger Municipal Hospital, Washington, D. C.
Lanning, Theodore Reuney Kings County Hospital, Brooklyn, N. Y.
Leibman, Jack Mount Zion Hospital, San Francisco, Cal.
Ley, Leo Henry, Jr. St. Agnes Hospital, Baltimore, Md.
Lister, Leonard Melvin Barnes Hospital, St. Louis, Mo.
MacDonald, James Melvtn U. S. Naval Hospital, Bethesda, Md.
McFadden, Earl Boyd Spartanburg General Hospital, Spartanburg, S. C.
McFadden, John William St. Luke's Hospital, Cleveland, Ohio
McGrady, Charles Winfred, Jr Gallinger Municipal Hospital, Washington, D. C.
McGrady, Kathleen Reilly Gallinger Municipal Hospital, Washington, D. C.
Mendez Bryan, Ricardo Tomas Fajardo District Hospital, Fajardo, Puerto Rico
Metcalf, John Shelby, Jr University Hospital, Baltimore, Md.
Mosser, Robert Schaaf University Hospital, Baltimore, Md.
Mutter, Arthur Zelig Michael Reese Hospital, Chicago, 111.
Myers, Donald Johnson McKeesport Hospital, McKeesport, Pa.
Nygren, Edward Joseph
The New York Hospital, Cornell Medical Center, New York, N. Y.
Orth, John Stambaugh Tripler General Hospital, Oahu, Ha.
Packard, Douglas Richard Elizabeth Buxton Hospital, Newport News, Va.
Pencheff, Dorris Marie Los Angeles County General Hospital, Los Angeles, Cal.
Pertlla, Frank Robert Mercy Hospital, Baltimore, Md.
Perry, Henry David, Jr University Hospital, Baltimore, Md.
Reeser, Guy McClelland, Jr Lutheran Hospital of Maryland, Inc., Baltimore, Md.
Reeves, Henry Gray, Jr University Hospital, Baltimore, Md.
SCHOOL OF MEDICINE 101
Rex, Eugene Braiden University Hospital, Baltimore, Md.
Reynolds, Georgia Gallinger Municipal Hospital, Washington, D. C.
Richardson, Aubrey De Vaughn University Hospital, Baltimore, Md.
Rombro, Marvin Jay Lutheran Hospital of Maryland, Inc., Baltimore, Md.
Rowland, Harry Shepard, Jr Jersey City Medical Center, Jersey City, N. J.
Saavedra Amador, Armando St. Joseph's Hospital, Baltimore, Md.
Schmale, Arthur Henry, Jr University Hospital, Baltimore, Md.
Scott, Roger David University Hospital, Baltimore, Md.
Scully, John Thorsen Youngstown Hospital Association, Youngstown, Ohio
Shea, William Harold Holland Mercy Hospital, Baltimore, Md.
Sherry, Samuel Norman Sinai Hospital, Baltimore, Md.
Simmons, Leslie Dale Mercy Hospital, Baltimore, Md.
Sd?ple, Edward M Mercy Hospital, Baltimore, Md.
Sklpton, Roy Kennedy University Hospital, Baltimore, Md.
Solomon, Davtd Milton Sinai Hospital, Baltimore, Md.
Stone, John Hosktns Mercy Hospital, Baltimore, Md.
Sutton, Julian Theoplous Charlotte Memorial Hospital, Charlotte, N. C.
Tobias, Richard Boyd The Williamsport Hospital, Williamsport, Pa.
Twigg, Homer Lee, Jr U. S. Marine Hospital, Boston, Mass.
Udel, Melvtn U. S. Marine Hospital, Baltimore, Md.
Venrose, Robert James U. S. Marine Hospital, New Orleans, La.
Watson, Charles Polk, Jr University Hospital, Baltimore, Md.
Weekley, Robert Dean St. Luke's Hospital, Cleveland, Ohio
Wheelwright, Harvey Pearse U. S. Marine Hospital, Seattle, Wash.
Williams, Charles Ray U. S. Marine Hospital, San Diego, Cal.
York, Shelley Clyde, Jr Medical College of Virginia, Richmond, Va.
York, Thomas Luther U. S. Marine Hospital, Galveston, Texas
Young, Calvin Lessey U. S. Marine Hospital, Staten Island, N. Y.
MATRICULANTS
SENIOR CLASS, SEPTEMBER 21, 1950 TO JUNE 9, 1951
Ager, Law Lamar, B.S., University of North Carolina, School of Medicine, Septem-
ber 1947 to June 1949 North Carolina
Arthur, Robert Key, Jr., B.S., Mercer University, 1948 Georgia
Barthel, John Paul, Western Maryland College Maryland
Beardsley, Earl Miller, University of Maryland Maryland
Bell, Arthur Keith, A.B., Oberlin College, 1947 Maryland
Bilder, Joseph, Jr., B.S., University of Akron, 1944 Ohio
Birely, Beverly Robert, University of Maryland Maryland
Blades, Nancy, A.B., Connecticut College, 1947 New Jersey
Bossard, John Wesley, A.B., Duke University, 1947 Maryland
Brannon, John Vandale, B.S., Fairmont State Teachers College, 1948. .West Virginia
Buell, John Russell, Jr., University of Maryland Maryland
Christopher, Russell Lee, A.B., Bowdoin College, 1947 Massachusetts
Clemmens, Raymond Leopold, B.S., Loyola College, 1947 Maryland
Copfman, Kaohlin Miner, A.B., Western Maryland College, 1947 Pennsylvania
Cohen, Solomon, A.B., University of Denver, 1947 Maryland
Curanzy, Raymond Ralph, B.S., Juniata College, 1947 Pennsylvania
Deckelbaum, Joseph, B.S., University of Maryland, 1947 Maryland
Dettbarn, Ernest Albert, B.S., Randolph-Macon, 1947 Maryland
Donner, Leon, B.S., State Teachers College, 1942 Maryland
Dudley, Winston Clark, A.B., Oberlin College, 1943 Massachusetts
Dunn, George Mitchell, Jr., George Washington University. . . .District of Columbia
Dunigan, William Andrew, A.B., University of North Carolina, School of Medi-
cine, September 1947 to June 1949 North Carolina
102 UNIVERSITY OF MARYLAND
Edwards, David Everett, University of Maryland District of Columbia
Edwards, William Hunter, Jr., A.B., Johns Hopkins University, 1940 Maryland
Esmond, William George, B.S., University of Maryland, 1940 Maryland
Evans, Otis Drdell, Jr., B.S., Davidson College, 1947 North Carolina
Ferguson, Charles Kirkpatrick, Muskingum College Kansas
Fitzgerald, Joseph Carroll, Middlebury College, 1947 Maryland
Fullilove, Jack, University of Georgia Georgia
Gallaher, James Patrick, B.A., West Virginia University, 1947 West Virginia
Garcia Palmieri, Mario Ruben, B.S., University of Puerto Rico Puerto Rico
Gardner, Francis, Sujney, Jr., A.B., University of North Carolina, School of
Medicine, September 1947 to June 1949 North Carolina
Gates, John Butler, University of Wisconsin Wisconsin
Gordon, Benjamin Dichter, B.A., Amherst College, 1947 New York
Hatem, Frederick Joseph, B.S., Georgetown University, 1947 Maryland
Hopkins, Robert Charles, B.S., Allegheny College, 1946 Pennsylvania
Iten, George Joseph, A.B., Goshen College, 1946 California
Johnson, Frederick Miller, B.S., M.S., University of Maryland, 1943-1947
District of Columbia
Johnson, Wallace Edward, Wesleyan University New Hampshire
Kaschel, Paul Edward, A.B., Wheaton College, 1947 New Jersey
Kindt, Wlllard Freed, Muhlenberg College Pennsylvania
King, Victor Francis, University of Maryland Maryland
Kipnis, David Morris, A.B., A.M., Johns Hopkins University, 1945-1949. . .Maryland
Knipp, Harry Lester, Loyola College Maryland
Kramer, Howard Calvin, University of Maryland Maryland
Lamb, William Eugene, B.S., University of Florida, 1947 Florida
Lanning, Theodore Reuney, B.S., Springfield College, 1944 New Jersey
Leibman, Jack, A.B., Johns Hopkins University, 1947 Maryland
Ley, Leo Henry, Jr., ML St. Mary's College of Maryland Maryland
Lister, Leonard Melvin, Loyola College Maryland
MacDonald, James Melvin, B.S., Loyola College, 1947 Maryland
McFadden, Earl Boyd, B.S., University of Maryland, 1947 Maryland
McFadden, John William, Mt. Union College Ohio
McGrady, Charles Winifred, Jr., A.B., Emory University, 1947 Georgia
McGrady, Kathleen Reilly, B.S., Long Island University, 1947 New York
Mendez Bryan, Ricardo Tomas, University of Puerto Rico Puerto Rico
Metcalf, John Shelby, Jr., B.S., University of California, 1950 California
Mosser, Robert Schaaf, B.S., University of Maryland, 1949 Maryland
Mutter, Arthur Zelig, B.S., Franklin & Marshall College, 1947 Maryland
Myers, Donald Johnson, B.S., Bethany College, 1934 Ohio
Nygren, Edward Joseph A.B., Western Maryland College, 1947 Maryland
Orth, John Stambaugh, University of Maryland Maryland
Packard, Douglas Richard, University of Maryland Maryland
Pencheff, Dorris Marle, A.B., University of California, 1946 California
Perilla, Frank Robert, B.S., University of Maryland, 1947 Maryland
Perry, Henry David, Jr., A.B., Emory University, 1947 Florida
Reeser, Guy McClelland, Jr., A.B., Western Maryland College, 1947 Maryland
Reeves, Henry Gray, Jr., B.S., Wake Forest College, 1947 North Carolina
Rex, Eugene Braiden, Vanderbilt College Colorado
Reynolds, Georgia, A.B., Western Maryland College, 1947 Maryland
Richardson, Aubrey DeVaughn, B.S., University of North Carolina, School of
Medicine, Sept. 1947 to June 1949 North Carolina
Rombro, Marvin Jay, A.B., Bucknell University, 1947 Maryland
Rowland, Harry Shepard, Jr., A.B., Wesleyan University, 1947 New Jersey
Saavedra Amador, Armando, University of Puerto Rico Puerto Rico
Schmale, Arthur Henry, Jr. Pennsylvania State College Nebraska
Scott, Roger, David, University of Virginia Florida
Scully, John Thorsen, Indiana University Indiana
Shea, William Harold Holland, B.S., Loyola College, 1947 Maryland
Sherry, Samuel Norman, B.S., University of Maryland, 1949 Maryland
Simmons, Leslie Dale, B.S., West Virginia University, School of Medicine
Sept. 1947 to June 1949 West Virginia
Sipple, Edward M., B.A., Earlham College, 1949 Maryland
SCHOOL OF MEDICINE 103
Skipton, Roy Kennedy, B.S., University of Maryland, 1942 Maryland
Solomon, David Milton, University of Maryland Maryland
Stone, John Hoskins, B.S., University of Maryland Maryland
Sutton, Julian Theoplous, A.B., University of North Carolina, School of Medi-
cine, September 1947 to June 1949 North Carolina
Tobias, Richard Boyd, B.S., Bucknell University, 1947 Pennsylvania
Twigg, Homer Lee, Jr., University of Maryland Maryland
Udel, Melvtn, A.B., University of Maryland, 1947 Maryland
Venrose, Robert James, A.B., University of Michigan, 1946 Ohio
Watson, Charles Polk, Jr., A.B., West Virginia University, 1947 West Virginia
Weekley, Robert Dean, B.S., Heidelberg College, 1947 Ohio
Wheelright, Harvey Pe arse, Brigham Young University Utah
Williams, Charles Ray, A.B., Gettsburg College, 1947 Maryland
York, Shelley Clyde, Jr., B.S., Guilford College, 1947 North Carolina
York, Thomas Luther, A.B., University of North Carolina, School of Medicine
Sept. 1947 to June 1949 North Carolina
Young, Calvin Lessey, A.B., Haverford College, 1947 Maryland
JUNIOR CLASS, SEPTEMBER 21, 1950 TO JUNE 9, 1951
Adams, Charles Baird, Jr., University of Maryland Maryland
Adelstein, Benjamin Alfred, A.B., University of Pennsylvania, 1948 Pennsylvania
Adkins, Charles Glen, West Virginia University West Virginia
Ahlquist, Richard Elmer, Jr., A.B., Stanford University, 1948 Washington
Alderman, George Carl, Jr., B.S., Loyola College, 1949 Maryland
Andrews, James William, B.S., Muskingum College, 1948 Ohio
Atkins, Raymond Melvln, University of Maryland Maryland
Bakal, Daniel, B.S., Loyola College, 1948 Maryland
Baker, Timothy Danford, A.B., Johns Hopkins University, 1948 Maryland
Bergofsky, Edward Harold, University of Maryland Maryland
Berrios, Osvaldo, University of Puerto Rico Puerto Rico
Bridges, Jack Arthur, University of Maryland Maryland
Brittain, Lowell Ellis, A.B., University of North Carolina, School of Medicine,
September 1948 to June 1950 North Carolina
Brooks, James Burch, B.S., Loyola College, 1948 Maryland
Brown, William Morris, Jr., A.B., Mercer University, 1948 Georgia
Carroll, John Edward, Jr., Loyola College Maryland
Carson, Jack Oliver, B.S., University of North Carolina, School of Medicine,
September 1948 to June 1950 North Carolina
Clyman, Daniel, B.S., University of Maryland, 1948 Maryland
Cohen, Phtn, Duke University Maryland
Culpepper, Stuart Pitner, B.S., University of Georgia, 1948 Florida
Devlin, Andrew Joseph, B.S., Gonzaga University, 1948 Washington
Diggs, Andrew Monroe, B.S., University of North Carolina, School of Medicine,
September 1948 to June 1950 North Carolina
DiGiovanni, Anthony John, A.B., Johns Hopkins University, 1948 Maryland
Douglas, Robert Arnold, B.S., /. B. Stetson University, 1948 Florida
Douglass, Robert Corl, Jr., B.S., University of Toledo, 1947 Ohio
Dunford, William Stanley, Jr., B.S., Brigham Young University, 1948 Utah
Eakle, Burke Eldridge, West Virginia University West Virginia
Eckert, Herbert Lewis, University of Maryland Maryland
Egbert, Lawrence Deems, Jr., A.B., Johns Hopkins University, 1948 Maryland
Elgin, Lee William, Jr., University of Florida Florida
Elliott, Charles Stanley, Emory University Florida
Feski, Joseph Paul, University of Pittsburgh Pennsylvania
Fine, Jack, University of Maryland Maryland
Foley, Michael Joseph, West Virginia University West Virginia
Fritz, Louis Albert, B.S., Loyola College, 1948 Maryland
Gebhardt, Robert William, University of Maryland Maryland
Gilliam, Charles Franklin, A.B., University of North Carolina, School of Medi-
cine, September 1948 to June 1950 North Carolina
Gislason, Paul Harold, A.B., University of North Dakota, 1948 North Dakota
Gonzalez, Luis Felipe, University of Maryland Puerto Rico
Gore, Jay Calvin, A.B., Western Maryland College, 1948 Maryland
104 UNIVERSITY OF MARYLAND
Grabill, James Rodney, Georgetown University, A merican University Maryland
Graham, David Eric, B.S., University of North Carolina, Medical School, Sep-
tember 1948 to June 1950 North Carolina
Graybeal, Clarence Edward, University of Maryland Maryland
Greco, William Richard, University of Maryland Maryland
Grubb, Robert Alvin, University of Maryland Maryland
Hankoff, Leon Dudley, University of Maryland Maryland
Harris, William Benjamine, A.B., University of North Carolina, School of Medi-
cine, September 1948 to June 1950 North Carolina
Heimer, William Lenox, B.S., University of Maryland, 1948 Maryland
Holmes, Charles Martin, University of Miami Maryland
Houck, Romulus Vance, Jr., University of Maryland Maryland
Hudgins, William Baird, A.B., Emory University, 1948 Georgia
Hunter, DeWitt Talmade, Jr., B.S., U. S. Naval Academy, 1945 Virginia
Hunter, Laurel Mullins, A.B., W esthampton College, 1948 Maryland
Hyatt, Irvtn, B.S., University of Maryland Maryland
Keller, Franklin Lloyd, A.B., Gettysburg College, 1945 Maryland
Kline, Frank Menefee, University of Maryland Maryland
Knell, Joseph Anthony, Jr., A.B., Loyola College, 1948 Maryland
Krager, John Martin, B.S., Loyola College, 1948 Maryland
Kramer, Irvtn, New York University Maryland
Krteger, Morton Morris, University of Maryland Maryland
Lapp, Herbert Walter, Seton Hall College New Jersey
Lightbody, Charles Harry, A.B., Colby College, 1948 Maine
Love, Robert George, B.S., Massachusetts State College, 1947 Massachusetts
Mathews, William Allen, Westminster College, A.B., Wittenberg College Ohio
McKay, John Nelson, Ohio Wesleyan University, Gettysburg College Maryland
Olsen, Richard Young, A.B., University of California, 1948 California
Perry, Benton Bloch, B.S., University of Chicago, 1947 Maryland
Pillsbury, William Andrew, Jr., University of Oregon, Loyola College Maryland
Potter, Vance Edward, University of Maryland Maryland
Rabinowich, Malcolm Lee, University of Maryland Maryland
Ramirez-Santisteban, Gilberto, University of Puerto Rico Puerto Rico
Rappeport, Jonas Ralph, University of Maryland Maryland
Rasmussen-Taxdal, David Samuel, University of Maryland Pennsylvania
Reed, Julian Ward, B.S., University of Maryland Maryland
Rosson, William Daniel, University of Maryland Maryland
Schtmmel, Bella Faye, B.S., University of Michigan, 1948 Maryland
Sharrett, John Oliver, University of Virginia Maryland
Shoff, Mahlon James, A.B., University of Delaware, 1948 Delaware
Sindler, Richard Arnold, A.B., Johns Hopkins University, 1948 Maryland
Slager, Ursula Traugott, A.B., Wellesley College, 1948 Maryland
Smith, Bolyston Dandrtdge, West Virginia University West Virginia
Smith, George Herbert, A.B., Clark University, 1948 Maine
Smoot, Aubrey Cannon, Jr., University of Delaware Delaware
Spritz, Norton, A.B., Johns Hopkins University, 1948 Maryland
Stambler, Alvin Abraham, University of Maryland Maryland
Starling, Charles Ray, B.S., University of North Carolina, Scliool of Medicine,
September 1948 to June 1950 North Carolina
Trace, Robert James, University of Wisconsin Wisconsin
Troutman, Belk Connor, University of North Carolina, School of Medicine,
September 1948 to June 1950 North Carolina
Vicens, Carlos Nathaniel, B.S., University of Puerto Rico, 1948 Puerto Rico
Wallace, Scott, Pyper, A.B., University of Utah, 1948 Utah
Walsh, Harry Martin, B. S., Washington College, 1948 Maryland
Warren, Bryan Pope, Jr., University of Maryland Maryland
Watters, John Lord, A.B., University of North Carolina, School of Medicine,
September 1948 to June 1950 North Carolina
Weeks, Howard Nelson, B.S., Franklin & Marshall, 1948 Maryland
Wildberger, Albert John, A.B., Western Maryland College, 1948 Maryland
Wilkinson, John Ross, Jr., A.B., University of North Carolina, School of Medicine,
September 1948 to June 1950 North Carolina
Wolfel, Donald Anthony, University of Maryland Maryland
Wolverton, William Roger, A.B., West Virginia University, 1948 West Virginia
SCHOOL OF MEDICINE 105
SOPHOMORE CLASS, SEPTEMBER 21, 1950 TO JUNE 9, 1951
Arp, Louis Croft, Jr., A.B., State University of Iowa, 1949 Illinois
Baldwin, Richard Moffett, B.S., Loyola College, 1949 Maryland
Banks, James Leroy, Jr., B.S., Furman University, 1949 South Carolina
Bastian, Grace Arlene, B.S., College of Notre Dame of Maryland, 1949 Maryland
Beck, George Henry, A.B., Western Maryland College, 1949 Maryland
Berkow, Robert, B.S., University of Maryland, 1949 Maryland
Blumenfeld, Samuel, A.B., University of Maryland, 1949 Maryland
Boggs, James Ernest, A.B., West Virginia University, 1949 West Virginia
Bove, Joseph Richard, B.S., University of Maryland New Jersey
Brinkley, George Ross, Jr., A.B., West Virginia University, 1949 West Virginia
Burkart, Thomas Joseph, B.S., Loyola College, 1949 Ohio
Byerly, Walter Houch, A.B., Johns Hopkins University, 1949 Maryland
Byrnes, Bernard Joseph, Jr., B.S., Loyola College, 1949 Maryland
Carroll, Charles Fisher, Jr., B.S., Guilford College, 1949 North Carolina
Carter, Donald Sweetser, Duke University Maryland
Clift, John Vinton, B.S., Hampden-Sydney College, 1949 Maryland
Codington, John Bonnell, B.S., Davidson College, 1949 North Carolina
Cohen, Jerome, B.S., University of Maryland Maryland
Colon-Lugo, Salomon, University of Puerto Rico Puerto Rico
Cook, Arthur John, A.B., Emory University, 1949 Georgia
Doerner, Wyand Francis, Jr., B.S., Mt. St. Mary's College, 1949 Maryland
Dowell, Rowland Judson, University of Utah Utah
Dumler, John Donald, B.S., University of Maryland Maryland
Edlow, Jules Bernard, B.S., University of Maryland Maryland
Eye, Harry Luke, A.B., West Virginia University, 1949 West Virginia
Firor, Hugh Valentine, University of Georgia Georgia
Flax, Leonard Harold, B.S., University of Maryland Maryland
Freeman, Sylvan, B.S., University of Maryland, 1949 Maryland
Garlock, Frederick Adams, B.S., University of Maryland Maryland
Garrison, Joseph Shermer, 3d, A.B., Western Maryland College, 1949 Maryland
Gevas, George, B.S., University of Maryland, 1949 Maryland
Gillotte, Joseph Patrick, B.S., University of Maryland Connecticut
Glick, Leonard Barry, B.S., University of Maryland Maryland
Goldstein, Robert Bruce, University of Maryland Maryland
Hartman, John McMaster, A.B., West Virginia University, 1949 West Virginia
Heisse, John Wilbur, Jr., A.B., Johns Hopkins University, 1949 Maryland
Henson, Kenneth Clifford, B.S., Salem College, 1949 Maryland
Herbert, Thomas Franklyn, Johns Hopkins University Maryland
Hess, Charles Franklin, A.B., McPherson College, 1949 Pennsylvania
Himmel wrighT, George Overton, B.S., University of Maryland Maryland
Holder, William Lewis, A.B., Emory University, 1949 Georgia
Jones, Henry Albert, Jr., Johns Hopkins University Maryland
Jones, Thomas Lawson, B.S., University of Maryland Maryland
Judge, Walter Francis, B.S., University of Notre Dame, 1949 .New Jersey
Kaese, Werner Erich, B.S., Albright College, 1949 Pennsylvania
Karn, William Nicholas, Jr., Alfred University Maryland
Kingsbury, Robert Coburn, B.S., University of Maryland Maryland
Kiser, William Sites, B.S., University of Maryland West Virginia
Knight, Arthur Clyde, University of Montana Montana
Lambert, Robert Young, A.B., Emory University, 1949 South Carolina
Langrall, Harrison Morton, Jr., A.B., Johns Hopkins University, 1949 Maryland
Lee, Benjamin Buck, A.B., Johns Hopkins University, 1949 Maryland
Leighton, Herbert Houck, Western Maryland College Maryland
Levine, Robert Lee, B.S., University of Maryland Maryland
Longo-Cordero, Rafael, University of Puerto Rico Puerto Rico
Madge, Gordon Evans, College of William and Mary Maryland
McCurry, Don Meredith, B.S., Jr., University of Maryland Maryland
McFadden, Archibald Weems, B.S., University of Maryland Virginia
Mendelsohn, Ronald Edward, B.S., University of Maryland, 1949 Maryland
Metcalf, John William, Jr., Kent State University Ohio
Middleton, Benjamin Martin, University of Maryland Maryland
Might, James Edward, A.B., Wittenberg College, 1949 Ohio
106 UNIVERSITY OF MARYLAND
Miles, Leslie Roy, Jr., A.B., West Virginia University, 1949 Pennsylvania
Miller, George Henry, B.S., University of Maryland Maryland
Miller, Norman Louis, B.S., University of Maryland Maryland
Novey, Riva Esther, A.B., Goucher College, 1935, M.S., Smith College, 1938 . . . .Maryland
Palmisano, Joseph Frank, B.S., University of Maryland Maryland
Peck, George Charles, A.B., Johns Hopkins University, 1949 Maryland
Powder, James Richard, A.B., Johns Hopkins University, 1949 Maryland
Read, James Lamar, B.S., University of Maryland, 1949 Maryland
Richardson, Joe Bernal, A.B., Emory University, 1949 Georgia
Richmond, Lewis Cass, Jr., Duke University West Virginia
Rowe, James Earle, Jr., B.S., University of Maryland Maryland
Schindler, Richard Elias, B.S., University of Maryland Maryland
Shuman, Joseph Ellyn, B.S., Washington College, 1949 Maryland
Singleton, Robert Tiffany, B.S., University of Maryland Maryland
Skaggs, Thomas Wayne, B.S., University of Miami, 1947 Florida
Slasman, William Howry, Jr., A.B., Johns Hopkins University, 1949 Maryland
Smith, William Meredith, Jr., B.S., Mt. St. Mary's College, 1949 Maryland
Spudis, Edward Verhines, B.S., University of Maryland Washington, D. C.
Stauffer, John Craig, A.B., Princeton University, 1949 Maryland
Templeton, William Pendleton, B.S., University of Maryland Maryland
Treiber, Martin William, B.S., University of Maryland, 1948 Maryland
Troxel, James Roy, A.B., Johns Hopkins University, 1948 Maryland
Tyson, William Alva Way, B.S., Dickinson College, 1949 Maryland
Vance, Arnold Leonard, B.S., University of Maryland Maryland
Walter, Herbert Guy, Jr., University of Nevada Nevada
Watson, Jack Thomas, B.S., U. S. Naval Academy, 1945 West Virginia
Weaver, Karl Hanna, West Virginia University West Virginia
Webster, Joel Stoops, B.S., University of Maryland Maryland
Weeks, Harry Stephen, Jr., A.B., West Virginia University, 1949 West Virginia
Weiner, Israel Howard, A.B., Johns Hopkins University, 1949 Maryland
FRESHMAN CLASS, SEPTEMBER 21, 1950 TO JUNE 9, 1951
Abrams, Samuel Joseph, B.A., Johns Hopkins University, 1950 Maryland
Ault, Virginia Lee, B.S., University of Maryland, 1950 Maryland
Baitch, Arthur, University of Maryland Maryland
Barr, John William, B.C.S., University of Georgia, 1948 Maryland
Bauernschub, George Marbry, Jr., B.S., Loyola College, 1950 Maryland
Beach, Robert William, III, B.A., Yale University, 1950 Maryland
Bechtold, Jean Carol, University of Maryland Maryland
Berck, Beverly Jean, B.A., Asbury College, 1950 Maryland
Bernardo, Anthony A., B.S., University of Maryland, 1950 Rhode Island
Berntson, Dale Rampston, B.A., University of Utah, 1949 Utah
Besson, Edwin Henry Taylor, B.S., Washington College, 1950 Maryland
Betz, Richard Norman, B.A., Johns Hopkins University, 1950 Maryland
Blumenfeld, Herbert Lee, University of Maryland Maryland
Brown, Stuart Morton, University of Maryland Maryland
Bullock, Allen Culpepper, Jr., B.S., Bates College, 1950 Maine
Carney, Mary Kathleen, B.A., College of Notre Dame, 1950 Maryland
Cohen, Earl, University of Maryland Maryland
Coyle, Jean Marie, University of Maryland Maryland
Defendini, Efrain Antonio, University of Puerto Rico Puerto Rico
Doran, William Francis, B.S., Allegheny College, 1950 Pennsylvania
Edwards, Arthur George, Jr., University of Maryland Maryland
Ellin, Morton Jack, University of Maryland Maryland
Epstein, Yale, University of Maryland Maryland
Evans, Theodore Edward, B.S., Loyola College, 1950 Maryland
Fields, Ann, B.S., University of Maryland, 1947 Maryland
Fitch, Charles Thomas, B.S., George Washington University, 1950 Maryland
Forrest, Otto Norman, Jr., B.A., Duke University, 1949 Maryland
Framm, Daniel Herschel, University of Maryland Maryland
Freed, Malcolm Fellx, University of Maryland Maryland
Fritz, George Suppes, University of Maryland Maryland
Fruth, Richard Lawrence, B.A., M.S., W. Va. University, 1949, 1950. . . .West Virginia
Funkhouser, George Richard, B.S., Franklin and Marshall College, 1950. . . .Maryland
SCHOOL OF MEDICINE 107
Gable, Walter DeLay, University of Maryland Maryland
Gerwig, John Monroe, Jr., B.A., Johns Hopkins University, 1950 Maryland
Gessner, John Edward, B.S., Loyola College, 1950 Maryland
Glick, Louis Michael, Mt. St. Mary's College Maryland
Goldsmith, Ralph Samuel, B.S., Franklin and Marshall College, 1950 Maryland
Gunning, Jean Jacques, B.A., Loyola College, 1950 Maryland
Hall, Robert Lee, Washington College Maryland
Hammer, Charles John, Jr., B.A., Western Maryland College, 1950 Maryland
Hartman, John Frederick. B.S., Loyola Clllege, 1950 Maryland
Harvey, Harold Dewey, B.A., B.S., Southwest Missouri Slate Coll., 1950. . . .Missouri
Hatfield, William Henry, Jr., B.A., St. John's College, 1941 Maryland
Hayes, James Westcott, B.A., Johns Hopkins University, 1950 Maryland
Headley, William McKendree, B.A., University of Maryland, 1950 Maryland
Holcombe, Robert Calkins, B.A., Washington University, 1950 Illinois
Hopf, Edward Warren, B.S., Loyola College, 1950 Maryland
Houpt, William Pierre, B.A., Loyola College, 1950 Maryland
Hunt, Thomas Edward, Jr., B.A., West Virginia University, 1950 West Virginia
Jones, Richard Arvin, B.A., Brtdgeivater College, 1950 Maryland
Jones, Rosella Edith, B.A., Indiana University, 1949 Maryland
Kaplan, Irvin Bernard, B.S., University of Maryland, 1949 Maryland
Keefe, Raymond Bernard, B.S., College of the Holy Cross, 1950 Connecticut
Keester, Thomas Edward, B.A., Wittenberg College, 1950 Ohio
Klohr, Edward Smith, Jr., Western Maryland College Maryland
Knotts, Benjamin Franklin, Jr., B.A., Duke University, 1950 Florida
Lavtne Stanford A., B.S., University of Maryland, 1950 Pennsylvania
Levin, Herbert Joseph, B.S., University of Maryland, 1950 Maryland
Levine, Hilbert Merrill, B.A., Johns Hopkins University, 1950 Maryland
Levy, David Alfred, University of Maryland Maryland
Looff, David Henry, B.S., State College of Washington, 1950 Washington
Mawhinney, Charles, Jr., B.S., University of Pittsburgh, 1948 Pennsylvania
McGonigle, John Jerome, Jr., B.A., Holy Cross College, 1950 Massachusetts
Moss, Irwin Harold, B.A., Johns Hopkins University, 1949 Maryland
Mueller, Charles Herbert, Jr., B.S., Wheaton College, 1940 Maryland
Mueller, Eugene Alexander, B.S., Mt. Union College, 1949 Ohio
Murphy, John Daily, B.A., Centre College, 1950 Illinois
Nafzinger, Moses Leroy, B.S., Juniata College, 1950 Maryland
Nangle, Gerald Francis, B.A., Ohio State University, 1948 Maryland
Noya, Joseph, B.S., Franklin and Marshall College, 1950 Maryland
Owens, David, B.S., Loyola College, 1950 Maryland
Packard, Albert Gibson, Jr., B.A.., Johns Hopkins University, 1950 Maryland
Pats, Albert, B.S., University of Maryland, 1950 Maryland
Patten, David Hales, B.A., Western Maryland College, 1950 Maryland
Perez Arzola, Miguel, University of Puerto Rico Puerto Rico
Raab, Hellmugh, Florida Southern College Maryland
Rainess, Morris, B.A., Johns Hopkins University, 1950 Maryland
Roberts, Robert Reuel Richard, B.S., University of Maryland, 1950 Maryland
Schlenoff, Milton, B.S., University of Maryland, 1950 Maryland
Shamer, Margaret Gillette, B.A., Woman's College of the University of North
Carolina, 1948 Maryland
Shapiro, Jerome Edwin, B.A., Johns Hopkins University, 1949 Maryland
Shochet, Bernard Richard, University of Maryland Maryland
Simpson, Marshall Albert, Western Maryland College Delaware
Smith, Joseph Raymond, B.A., Union College, 1950 Pennsylvania
Smyth, James Walter, B.S., Loyola College, 1950 Maryland
Solon, Thomas John, University of Maryland New York
Teeter, James Herring, B.A., Gettysburg College, 1950 Maryland
Thames, Rufus, B.S., University of Florida, 1950 Florida
Tracy, Harold William, Jr., B.S., University of Maryland, 1950 Maryland
Trapnell, Henry Rogers, University of Virginia Maryland
Tublin, Ira Nathan, B.S., University of Maryland, 1950 Maryland
Wall, George Henry, B.S., University of Maryland, 1950 Maryland
Weiss, Harold Robert, University of Maryland Maryland
Welliver, Daniel Irvin, B.A., Western Maryland College, 1950 Maryland
Welton, William Arch, Jr., B.A., Harvard University, 1950 West Virginia
108
UNIVERSITY OF MARYLAND
White, Kenneth Howard, Jr., B.A., Youngstown College, 1950 Ohio
Whittaker, Arthur Vance, B.S., Geneva College, 1949 Pennsylvania
Wild, William Otto, B.S., Mt. Union College, 1950 Ohio
Wohl, Milton Jack, B.S., University of Dayton Maryland
Ytm, Robert Earl, B.S., University of Nevada, 1950 Nevada
INTRAMURAL POSTGRADUATE STUDENTS
July 1, 1950 to June 30, 1951
Surgical Anatomy
Barnett, William O., Tuscola, Miss. University of Tennessee
M.D.
Bloxom, John Madison, Mappsville, Va. University of Maryland
Jr., M.D.
Bonzelaar, Alvin, M.D. Holland, Michigan University of Michigan
Charbonneau, Aubln, Chicoutimi, Quebec, Laval University, Quebec
M.D. Can.
Cunnick, Paul C, M.D. Baltimore, Maryland University of Iowa
Faralno, Frank Anthony, Baltimore, Maryland University of Maryland
M.D.
Graves, Joseph W., M.D. Baltimore, Maryland Vanderbilt University
Gray, David B., M.D. Baltimore, Maryland University of Maryland
Jensen, Meredith N., Baltimore, Maryland Baylor College of Medicine
M.D.
Kuntz, David H, M.D. Los Angeles, Calif. University of Iowa State
Levine, Leon, M.D. Schenectady, New York Albany Medical College
Parrott, Frank S., M.D. Goldsboro, N. C. University of Maryland
Penton, Robert S., M.D. Wetumpka, Alabama John Hopkins Medical
School
Poole, Frank, M.D. Clay, W. Va. Duke University
Sison, Alfredo, M.D. Manila, Philippines Univ. of Philippines, Ma-
nila, Johns Hopkins School
of Hygiene and Public
Health
Tansey, John J., M.D. Catonsville, Maryland University of Maryland
Velez, Baltasar B., M.D. Havana, Cuba University of Havana
Verrone, Anthony C, Providence, Rhode Tufts College of Medicine
M.D. Island
Watt, Francis H., M.D. Thomasville, Ga. Johns Hopkins Medical
School
Weber, Harry, M.D. Baltimore, Maryland College of Medical Evan-
gelists
Experimental Surgery
From Baltimore City Hospitals
Blair, Emil, M.D. Savannah, Ga. Univ. of Georgia
Graves, Joseph W., M.D. Baltimore, Md. Vanderbilt Univ.
Penton, Robert S., M.D. Wetumpka, Ala. Johns Hopkins Med. School
From Mercy Hospital
Theuerkauf, Frank J., Erie, Pennsylvania University of Maryland
Jr., M.D.
From South Baltimore General Hospital
Adamson, John A., M.D. Baltimore, Md. Nebraska Medical College
Black, Daniel J., M.D. Fort Worth, Texas University of Chicago
Parent Charles-Henri, Quebec, Canada Laval University, Quebec
M.D.
From University Hospital
J. Carlton Godlove, M.D. Hagerstown, Md. University of Md.
Erwin R. Jennings, M.D. Milledgeville, Ga. University of Md.
Edw. P. Smith, Jr., M.D. Baltimore, Maryland University of Md.
Joseph H. Allen, Jr., Baltimore, Maryland University of Md.
M.D.
From St. Joseph's Hospital
Baltasar B. Velez, M.D. Havana, Cuba University of Havana
SCHOOL OF MEDICINE
109
EXTRAMURAL POSTGRADUATE STUDENTS
Physicians Attending 1950-1951 Extension Lectures
Bell, Royal A., M.D.
Brewer, David R., M.D.
Campbell, Robert van L.,
Dwyer, James R., M.D.
HlRSHMAN, PHILD? J., M.D.
Hoffman, Lloyd A., M.D.
HORNBAKER, JOHN H., M.D.
Keadle, Robert F., M.D.
Kneisley, Bender, B., M.D.
Kohler, George A., M.D.
LeVan, Gerald W., M.D.
Lusby, Frank F., M.D.
Miller, Victor D., M.D.
Mowrer, Charles L., M.D.
NOVENSTEIN, SrDNEY, M.D.
Poole, Ernest F., M.D.
Shaffer, Lester M., M.D.
Shealey, Walter H., M.D.
Stauffer, Ralph S., M.D.
Tabler, Homer, E., M.D.
Wells, Samuel R., M.D.
Young, Ralph F., M.D.
Young, Earl S., M.D.
Zimmerman, Ira M., M.D.
Hagerstown, Md.
Clearspring, Md.
Hagerstown, Md.
Hagerstown, Md.
Hagerstown, Md.
Hagerstown, Md.
Hagerstown, Md.
Hagerstown, Md.
Hagerstown, Md.
Smithsburg, Md.
Boonsboro, Md.
Hagerstown, Md.
Hagerstown, Md.
Hagerstown, Md.
Funkstown, Md.
Hagerstown, Md.
Hancock, Maryland
Sharpsburg, Md.
Hagerstown, Md.
Hancock, Md.
Hagerstown, Md.
Williamsport, Md.
Hagerstown, Md.
Williamsport, Md.
University of Md.
Jefferson Med. College
Duke University
University of Md.
University of Virginia
Johns Hopkins Med. School
University of Md.
University of Md.
University of Pa.
Universty of Md.
Jefferson Med. College
University of Md.
University of Pa.
University of Md.
University of Md.
Jefferson Med. College
University of Geneva
University of Md.
Jefferson Med. College
University of Md.
University of Md.
University of Md.
Hahnemann Med. College
University of Md.
Physicians Attending Postgraduate Seminar Given for the Maryland
Academy of General Practice at University Hospital
December 7, 1950
Edward J. Alessi, M.D., Baltimore, Md.
Walter A. Anderson, M.D., Baltimore,
Md.
Phtldbert Artigiani, M.D., Baltimore,
Md.
Irene Barrett, M.D., Bethesda, Md.
Eugene I. Baumgartner, M.D., Oakland,
Md.
M. Virginia Beyer, M.D., Sykesville, Md.
J. L. BrLLiNGSLEA, M.D., Westminster, Md.
Melvin N. Borden, M.D., Baltimore, Md.
John D. Bubert, M.D., Baltimore, Md.
Mary S. Bulkley, M.D., Towson, Md.
W. B. Culvell, M.D., Mt. Airy, Md.
Louis Dalmau, M.D., Pikesville, Md.
Robert E. Farber, M.D., Sparrows Point,
Md.
W. H. Foard, M.D., Manchester, Md.
Charles R. Foul, M.D., Westminster, Md.
James Frenkil, M.D., Baltimore, Md.
Joseph Friedman, M.D., Baltimore, Md.
Leonard H. Golombek, M.D., Baltimore,
Md.
Benjamin Highstein, M.D., Baltimore,
Md.
Irene L. Hitchman, M.D., Sykesville, Md.
Willard P. Hudson, M.D., Forest Hill,
Md.
A. B. Hughes, M.D., Baltimore, Md.
Lauriston L. Keown, M.D., Baltimore,
Md.
B. S. Kleiman, M.D., Baltimore, Md.
B. B. Kneisley, M.D., Hagerstown, Md.
George A. Kntpp, M.D., Baltimore, Md.
Lester N. Kolman, M.D., Baltimore, Md.
K. K. Krulevitz, M.D., Baltimore, Md.
Louis T. Lavy, M.D., Baltimore, Md.
Byruth Lenson-Lambros, M.D., Balti-
more, Md.
Gerald W. LeVan, M.D., Boonsboro, Md.
Stephen L. Magness, M.D., Catonsville,
Md.
James T. Marsh, M.D., Westminster, Md.
Lawrence Maryanov, M.D., Cambridge,
Md.
Louis R. Maser, M.D., Baltimore, Md.
Stephen C. Mockowich, M.D., Baltimore,
Md.
G. Allen Moulton, M.D., Westminster,
Md.
B. A. Moxness, M.D., Chevy Chase, Md.
Joseph R. Myerowitz, M.D., Baltimore,
Md.
N. E. Needle, M.D., Baltimore, Md.
Norbert C. Nitsch, M.D., Baltimore, Md.
Charles F. O'Donnell, M.D., Towson,
Md.
Harold B. Plummer, M.D., Preston, Md.
M. C. PoRTERFrELD, M.D., Hampstead,
Md.
Louis J. Pratt, M.D., Baltimore, Md.
John C. Rawlins, M.D., Federalsburg,
Md.
H. O. Robbins, M.D., Berlin, Md.
N. E. Sartorius, M.D., Pocomoke City,
Md.
110
UNIVERSITY OF MARYLAND
H. W. Scheye, M.D., Baltimore, Md.
L. R. Schoolman, M.D., Frederick, Md.
William Schtjman, M.D., Baltimore, Md.
Wm. S. Seymour, M.D., Easton, Md.
Lester M. Shaffer, M.D., Hancock, Md.
Benjamin I. Siegel, M.D., Pikesville, Md.
John H. Slaw, M.D., Baltimore, Md.
Gertrude Sonnenfeldt, M.D., Sykes-
ville, Md.
W. G. Speicher, M.D., Westminster, Md.
F. J. Townsend, Jr., M.D., Ocean City,
Md.
John P. Urlock, M.D., Baltimore, Md.
H. Vadoeski, M.D., Sykesville, Md.
Hugh W. Ward, M.D., Owings Mills, Md.
J. B. Wells, M.D., Baltimore, Md.
J. D. Wilson, M.D., Smithsburg, Md.
W. V. Winiarz, M.D., Sykesville, Md.
SUMMARY OF STUDENTS
September 21, 1950 to June 9, 1951
Medical Students Male
Senior Class 92
Junior Class 95
Sophomore Class 90
Freshman Class 92
Medical Students 369
Intramural Post-Graduate Students 148
Extramural Post-Graduate Students 24
emale
Total
4
96
3
98
2
92
8
100
17
386
10
158
0
24
541
27
568
GEOGRAPHICAL DISTRIBUTION OF MEDICAL STUDENTS
September 21, 1950 to June 9, 1951
California 4
Colorado 1
Connecticut 2
Delaware 3
District of Columbia 5
Florida 11
Georgia 9
Idaho
Illinois
Indiana
Kansas
Maine
1
3
1
1
3
Maryland 224
Massachusetts .
Missouri .
Montana .
Nebraska .
Nevada . .
New Hampshire 1
New Jersey 7
New York 3
North Carolina 22
North Dakota 1
Ohio 16
Pennsylvania 16
Rhode Island 1
South Carolina 2
Utah 5
Virginia 1
Washington 3
West Virginia 20
Wisconsin 2
United States Possessions
Puerto Rico 11
MEDICAL ALUMNI ASSOCIATION
OFFICERS 1951-1952
(Term beginning July 1, 1951 and ending June 30, 1952)
President
Daniel J. Pessagno, M.D.
Vice-Presidents
James T. Marsh, M.D. William E. Lennon, M.D. Harry L. Rogers, M.D.
Simon Brager, M.D., Secretary Edwin H. Stewart, Jr., M.D., Assistant
Secretary
Minette E. Scott, Executive Secretary Thurston R. Adams, M.D., Treasurer
SCHOOL OF MEDICINE
111
Board of Directors
Louis A. M. Krause, M.D., Chairman
Daniel J. Pessagno, M.D.
Simon Brager, M.D.
Edwin H. Stewart, Jr., M.D.
Thurston R. Adams, M.D.
Albert E. Goldstein, M.D.
Wetherbee Fort, M.D.
George H. Yeager, M.D.
William H. Trdplett, M.D.
Thomas K. Galvin, M.D.
Nominating Committee
Robert F. Healy, M.D., Chairman
Ernest I. Cornbrooks, Jr., M.D.
Frank K. Morris, M.D.
David Tenner, M.D.
Arthur Siwinski, M.D.
Library Committee
Milton S. Sacks, M.D.
Representatives to General Alumni Board
William H. Trdplett, M.D.
Thurston R. Adams, M.D.
John A. Wagner, M.D.
Representative, Editorial Board, Bulletin
Harry C. Hull, M.D.
Albert E. Goldstein, M.D.
Daniel J. Pessagno, M.D. (ex-officio)
Hospital Council
Alfred T. Gundry, M.D.
George F. Sargent, M.D.
Alumni Council
Louis H. Douglass, M.D.
Lewis P. Gundry, M.D.
ENDOWMENT FUND
The following constitute the Board of Trustees of this Fund:
Arthur M. Shipley, Chairman
Robertson Griswold
Harry Clifton Byrd
Albert Burns
H. Boyd Wylie, Secy.-Treas.
Charles Reid Edwards
Horace E. Flack
W. Conwell Smith
William P. Cole Jr.
This Board is incorporated by act of the Legislature of the State, its legal title
being "The Trustees of the Endowment Fund of the University of Maryland,"
and is independent and self-perpetuating. Its powers are limited to the expendi-
ture of the interest derived from the various funds, which is applied as directed by
donors for the benefit of the University. Contributions, donations and bequests
are solicited from Alumni and friends. They may be made to the general or Uni-
versity Fund, to the Medical Fund or to any other department of the University.
U intended for the School of Medicine, they may be given to the general medical
fund or to some special object, as building, research, library, pathology, hospital,
publication, laboratories, gymnasium, scholarship, medal, prize, etc., in which
case the wishes of the donor will be strictly regarded. Checks should be made
payable to The Trustees of the Endowment Fund of the University of Maryland,
H. Boyd Wylie, Treasurer, Lombard and Greene Streets, Baltimore-1, Maryland.
FORMS OF DEVISE OR BEQUEST
To Endowment Fund
I give, devise and bequeath to the Trustees of the Endowment Fund of the University
of Maryland, a corporation incorporated under the laws of the State of Maryland, for the
benefit of the Faculty of Medicine
(Here state amount or describe property)
To School of Medicine
I give, devise and bequeath to the Regents of the University of Maryland, a corporation
incorporated under the laws of the State of Maryland, for the benefit of the Faculty of
Medicine
(Here state amount or describe property)
112 UNIVERSITY OF MARYLAND
THE UNIVERSITY OF MARYLAND SCHOOL OF NURSING
The University of Maryland School for Nurses was established in the year 1889.
Since that time it has been an integral part of the University of Maryland, coming
under the same government. It is a non-sectarian school, the only religious serv-
ices being morning prayers.
The University Hospital is a general hospital containing about 435 beds. It
is equipped to give young women a thorough course of instruction and practice in
all phases of nursing.
Programs offered: The programs of study of the school are planned for two
groups of students: (a) the five-year group, (b) the 36-month group.
The requirements for admission to the five-year program of the School of Nurs-
ing are the same as for other colleges of the University. The completion of this
course entitles the student to the degree of Bachelor of Science from the University
of Maryland and to the diploma of the University Hospital School of Nursing.
The requirements for admission to the 36-month program are the satisfactory
completion of an academic course in an approved high school. The completion
of this course entitles the student to the diploma of the University of Maryland
School of Nursing.
Applications and catalogues may be obtained from the Director of the School
of Nursing, University Hospital, Baltimore 1, Md.
MERCY HOSPITAL SCHOOL OF NURSING
The Mercy Hospital School of Nursing was established 1899 and incorporated
on December 23, 1901. It is an integral part of Mercy Hospital and is under the
same government. It is accredited by the Maryland State Board of Examiners
of Nurses and the National Nursing Accrediting Service.
The University of Maryland, and Mount Saint Agnes College, in affiliation with
the Mercy Hospital School of Nursing, offer a five year combined academic and
nursing program. The completion of this course entitles the student to the degree
of Bachelor of Science from the University of Maryland and Mount Saint Agnes
College, and to the diploma of the Mercy Hospital School of Nursing.
Mercy Hospital affords exceptional advantages for the education of nurses.
It is a general hospital containing 348 beds, and offers opportunities for a thorough
and varied experience. By its institutional affiliation with the University of Mary-
land it secures professors who give to the student the results of their training and
experience in the fields of the medical and related sciences.
SUBJECT INDEX
Administrative Officers 7
Admission, Application for 49
Requirements for 49
Advisory Board of the Faculty 8
Advisory Committee 9
Alumni Association, officers of 110
Anaesthesiology, Department of 63
Anatomy, Department of 63
Developmental 64
Gross 64
Microscopic 64
Neuro 64
Application, for admission 49
for advanced standing 49
Art, Department of, as applied to medicine 64
Assistant Residents, extramural 22
Assistant(s), Faculty, Listing of 18
Research 21
Associates, Faculty, Alphabetic Listing of 13
Awards offered 58
Won 99
Bacteriology and Immunology, Dept. of 65
Baltimore City Hospitals, Staff of 41
Facilities at . 48
Baltimore Eye, Ear, and Throat Hospital Facilities 48
Bequests, Forms for Ill
Biological Chemistry, Dept. of 65
Board, Advisory, Faculty 8
Board of Regents 7
Buildings and Facilities 45
Calendar, Academic 1951-52 5
of days, months, etc 4
of post graduate training 90
Cardiology, Division of 66
Certificates, for National and State Boards 56
qualifying, State 51 and 55
Clinic, Medical care, Mercy 40
University 31
Clinical Pathology, Dept. of 66
Combined courses, Arts and Sciences with Medicine 51
Committee, Advisory 9
Executive, University Hospital 22
Courses, Organization of 62 to 92
Post Graduate 90
Curriculum, Organization of 62 to 90
Dates, opening, closing, examinations, registration, etc 5
113
114 UNIVERSITY OF MARYLAND
Degrees, Combined 56
Dentistry, Dept. of 66
Departments, Teaching (see alphabetic listing) 63 to 90
Dermatology and Syphilology, Dept. of 67
Developmental Anatomy (see Anatomy) 64
Director, Baltimore City Hospitals 41
University Hospital 22
Dispensary Building, description of 46
Reports — Mercy 41
University Hospital 31
Staff— Mercy 37
University Hospital 26
Embryology (see Anatomy) 64
Emeriti 8
Endowment Fund Ill
Equipment, required for students 55
Examination (s), Eye; before admission 56
National and State Board
Rules governing 57
Executive Committee, University Hospital 22
Extramural assistant residents, List of 22
Eye Examination for Freshmen 56
Faculty of Medicine, Listing of 9
Advisory Committee of 9
Board, Advisory, Members of 8
Fellows, Listing of 20
Fees, Activity and Services 53
Lodging and meals at City Hospitals 52
Payment of 52
Penalty for non-payment of 52
Refund of 58
Re-examination 52
Services , 52
Forms, for bequests Ill
Fund(s), Endowment Ill
Loan 61
Gastro-Enterology, Dept. of 67
Genito Urinary Surgery, Dept. of (See Urology) 90
Geographic distribution of students 1 10
Grading system 54
Graduates, Listing of 98
Graduation, Rules governing 54
Gynecology, Dept. of 68
Health, Student 53
Histology (see Anatomy) 64
History of the Medical School 44
History of Medicine, Dept. of 69
Honors awarded 99
Hospital(s), Baltimore City, Staff of 41
Baltimore Eye, Ear and Throat 48
SCHOOL OF MEDICINE 115
Kernan, Staff of 43
Mercy, Advisory board of 32
Board of Governors of 32
Buildings and Facilities at 47
Dispensary, Report for 41
Staff 37
Intern Staff 37
Resident and Intern Staff 37
Staff of 33
University, Director 22
Out Patient Report for 31
Executive Committee of 22
Out Patient Department 26
Resident and Intern Staff 25
Staff of 23
Housing, for students 56
Hygiene and Public Health, Dept. of 69
Index of names 118
Industrial Medicine and Surgery, Dept. of 69
Instructors, faculty, Listing of , 15
Interns, Rotating 26
Internships, graduates of 1951 99
Kernan Hospital for crippled children 43 to 48
Lecturers, faculty, Listing of 15
Legal Medicine, Dept. of 70
Library, facilities 45
regulations 56
Staff of the 90
Loan Funds 61
Matriculants, September 21, 1950-June 9, 1951 101
Meals and Lodging, Baltimore City Hospitals 52
Medical Alumni Association, Officers of 110
Medical Care, Clinic for, at Mercy Hospital 40
at University Hospital 31
of students. 53
Medical School buildings, Description of 45
History of the 44
Medicine, Assistant Residents in, Extramural 22
Medicine, Dept. of 70
Mercy Hospital, Staff of 33 to 40
Names, Index of 118
National and State Board Examinations
Certification to 57
Neuro Anatomy (see Anatomy) 64
Neurological Surgery, Dept. of 73
Neurology, Dept. of 74
Nursing Schools at,
Mercy Hospital 112
University Hospital 112
Obstetrics, Dept. of 74
116 UNIVERSITY OF MARYLAND
Officers, Administrative 7
Oncology, Dept. of 76
Ophthalmology, Dept. of 76
Organization of Curriculum 62 to 90
Orthopaedic Surgery, Dept. of 77
Otolaryngology, Dept. of 78
Otology, Dept. of 79
Outpatient Department, Mercy Hospital report 41
University Hospital report 30
Parking 56
Pathology, Dept. of 79
Pediatrics, Dept. of 80
Pharmacology, Dept. of 81
Physical Diagnosis, Dept. of 82
Physiology, Dept. of 83
Plastic Surgery, Dept. of 83
Postgraduate Calendar 91
Courses 91
Lecturers 92
Students 108
Prizes 58
Proctology, Dept. of 83
Professors, alphabetic listing of 9
Assistant, Listing of 12
Associate, Listing of 10
Psychiatry, Dept. of 84
Public Health, Hygiene and 69
Qualifying Certificates, State 51 and 55
Re-examination, Fee for 52
Refund of fees 58
Registration, Dates for 5
Late, penalty for (see Footnote) 5
Report, Dispensary, Mercy Hospital 41
University 31
Requirements for Admission 49
Research Assistants, Listing of 21
Residence, Definition of 52
Roentgenology, Dept. of 85
Rotating Internships 26
Rooms, (see Housing) 56
Rules, General 54
governing admission 49
governing advancement 54
governing equipment 55
governing graduation 54
governing transcripts 56
Library 56
Schedules, Class 93 to 97
Scholarships 58
SCHOOL OF MEDICINE 117
Schools, of the University 7
of nursing, at, —
Mercy 112
Univ. Hosp 112
Speech Training, Dept. of 86
Staff, Baltimore City Hospitals 41
Dispensary, Mercy Hospital 37
Dispensary, University Hospital 26
Intern, Mercy Hospital 37
Intern, University Hospital 25
Kernon Hospital for children 43
Mercy Hospital 33
Resident, Mercy Hospital 37
Resident, University Hospital 25
University Hospital 23
State and National Board Examinations
Certification to 57
Student(s), activities, fees for 53
Admission of 49
Application for admission 49
calendar of events 5
fees 53
Geographic distribution of, September 21, 1950-June 9, 1951 110
health 53
Postgraduate, Listing of (1950) 108
Qualifying certificates, State 51 and 55
requirements for admission 49
Re-examination, Fee for , 52
Resident status, explained 52
Summary of, September 21, 1950-June 9, 1951 110
Surgery, Dept. of 86
Plastic, Dept. of 83
Thoracic, Dept. of 89
Syphilology, (see Dermatology) 67
Thoracic Surgery, Dept. of 89
Transcripts, Cost of 56
Rules relating to 56
Tropical Medicine, Division of 89
Tuberculosis, Division of 89
University Hospital 22 to 32
Urology 90
Withdrawals, and Refunds 58
X-Ray, Dept. of 85
INDEX TO PERSONAL NAMES
Abramovitz, Leondard, 42
Abrams, John D., Jr., 18
Abrams, Robert C, 29, 77
Abrams, Samuel Joseph, 106
Acton, Conrad B., 13, 27, 71, 79
Adams, Charles Baird, Jr., 103
Adams, Thurston R., 12, 24, 29, 41, 69, 83, 87, 88,92,
110, 111
Adamson, John A., 108
Adelstein, Benjamin Alfred, 103
Adkins, Charles Glen, 103
Agee, Fred B., Jr., 18, 26, 27
Ager, Law Lamar, 98, 99, 101
Ahlquist, Richard Elmer, Jr., 103
Aisenberg, Myron S., 9, 24, 66
Akers, Shirley, 36
Alderman, George Carl, Jr., 103
Alessi, Edward J., 109
Allen, Joseph H., Jr., 108
Alvarez, Jose A., 18, 25, 73
Amberson, William R., 8, 9, 83
Andersch, Marie A., 13, 66, 71, 92
Anderson, A. Russell, 15, 84
Anderson, Franklin B., 8
Anderson, George W., 43
Andrews, James William, 103
Anderson, Walter A., 109
Anita, Sister M., 37
Ansberry, Merle, 10, 30, 86
Applegarth, Eva, 40
Arnold, James G., Jr., 8, 10, 22, 23, 33, 41, 73, 92
Arnold, Nancy, 40
Arp, Louis Croft, Jr., 105
Arthur, Robert Key, Jr., 105
Artigiani, Philibert, 109
Ashman, Leon, 13, 38, 71, 82
Atkins, Raymond Melvin, 103
Ault, Virginia Lee, 106
Ayd, Frank J., Jr., 39
Bacon, A. Maynard, Jr., 18, 35, 80
Baetjer, Walter A., 8
Baggott, Bartus T., 35
Bagley, Charles, Jr., 8, 9, 23, 33, 38, 41, 44, 73
Bagley, Charles, III, 25
Baitch, Arthur, 106
Bakal, Daniel, 103
Baker, J. Tyler, 13, 74
Baker, Timothy Danford, 103
Baldwin, Richard Moffett, 105
Baldwin, Ruth, 18, 28, 80
Ballard, Margaret B., 13, 30, 74
Banks, James Leroy, Jr., 105
Barnes, Thomas G., 18, 25
Barnett, Charles P., 13, 20, 66, 72, 79
Barnett, Donald J., 12, 24, 28, 86
Barnett, William O., 108
Barr, John William, 106
Barrett, Irene, 109
Barthel, John Paul, 98, 99, 101
Bastian, Grace Arlene, 105
Bauer, Robert E., 15, 26, 72, 92
Bauernschub, George Marbry, Jr., 106
Baumann, Jeno, 37
Baumgartner, Eugene I, 109
Beach, Robert William, III, 106
Beacham, Edmund G., 13, 42, 71, 82
Beardsley, Earl Miller, 98, 99, 101
Bechtold, Jean Carol, 106
Beck, George Henry, 105
Beck, Harry McB., 15, 18, 30, 36, 39, 68, 75
Beck, Harvey G., 8, 34
Behr, Eleanor, 36
Bell, Arthur Keith, 98, 101
Bell, Frederick K, 20, 81, 99
Bell, R. A., 109
Benavent, Walter J., 18, 83
Benson, John F., 22
Berck, Beverly Jean, 106
Bereston, Eugene S., 13, 23, 27, 34, 39, 67
Berger, Maryanne E., 21
Bergofsky, Edward Harold, 103
Berkow, Robert, 105
Bernadette, Mother M., 32
Bernardo, Anthony A., 106
Berntson, Dale Rampston, 106
Berrios, Osvaldo, 103
Berry, Rita, 36
Berry, Robert Z., 13, 34, 39, 78
Besson, Edwin Henry Taylor, 106
Betz, Richard Norman, 106
Beyer, M. Virginia, 109
Biddix, Joseph C, Jr., 9, 23, 66
Biehl, Harold P., 18, 33, 37, 87
Bilder, Joseph, Jr., 98, 99, 101
Billingslea, J. L., 109
Bimestefer, L. W., 43
Bird, Joseph G., 15, 26, 27, 72, 80, 92
Birely, Beverly Robert, 98, 101
Bisanar, James M., 25
Black, Daniel J., 108
Blades, Nancy, 98, 99, 101
Blair, Emil, 108
Bleakley, Jane L., 18, 64
Bloxom, John M., Jr., 108
Blum, Louis V., 13, 26, 28, 71
Blumenfeld, Herbert Lee, 106
Blumenfeld, Samuel, 105
Boehm, Jenifred S., 18, 64
Bogdonoff, Morton D., 43
Boggs, James Ernest, 105
Bongardt, Henry F., 12, 32, 33, 87
Bonzelaar, Alvin, 108
Borden, Melvin N., 18, 28, 80, 109
Bordley, John, 42
Borges, Francis Joseph, 25
Bossard, John Wesley, 26, 98, 99, 101
Bove, Joseph Richard, 105
119
120
INDEX TO PERSONAL NAMES
Bowie, Harry C, 13, 41, 63, 87, 88, 92
Bowyer, Thomas S., 15, 68
Boyd, C. Holmes, 42
Boyd, Kenneth B., 13, 68, 75
Bracken, John T., 15, 86
Bradford, George S., 20
Bradley, J. Edmund, 8, 9, 22, 23, 44, 80, 91, 92
Brady, Frank J., 13, 24, 63
Brady, Leo, 12, 25, 68
Brager, Simon H., 12, 32, 33, 34, 40, 83, 87, 89, 110, 111
Brahen, Leonard S., 20, 81
Brambel, Charles E., 15, 36, 71
Brannon, John Vandale, 98, 99, 101
Brantigan, Otto C, 8, 9, 23, 41, 63, 86, 88, 89, 91, 92
Brendan, Sister M., 110
Bressler, Frank C, 45
Brewer, David R., 109
Bridges, Jack Arthur, 103
Briele, Henry A., 13
Brinkley, George Ross, Jr., 105
Briscoe, Ruth Lee, 8
Brittain, Lowell Ellis, 103
Bronushas, Joseph Benedict Bernard, 25
Brooks, James Burch, 103
Brooks, Ross C., 18, 24, 78
Brouillet, George H., 15, 87, 92
Brown, Ann Virginia, 15, 65
Brown, B. Herbert, Jr., 7
Brown, Frances C., 18, 83
Brown, Richard E., 21, 65
Brown, Stuart Morton, 106
Brown, William Morris, Jr., 103
Browne, James S., 20, 25, 73
Brumback, Frank E., 15, 76
Brumback, J. E., Jr., 25, 30
Brunst, Catherine S., 21
Brunst, V. V., 13, 63
Bryant, Samuel H., 67
Bryson, William J., 79, 110
Bubert, Howard M., 8, 11, 23, 27, 70, 90, 92
Bubert, John D., 109
Buchness, A. V., 18, 87
Buck, George H., 8, 22
Buell, John Russell, Jr., 37, 98, 99. 101
Bulkely, Mary S., 109
Bullock, Allen Culpepper, Jr., 106
Bundick, William R., 13, 27, 34, 39, 67
Burgin, Bernard, 18, 72, 82
Burgison, Raymond M., 8, 12, 81
Burkart, Thomas Joseph, 105
Burns, Albert, 111
Burns, Harold H., 13, 33, 37, 87
Burns, J. Howard, 35, 36
Butler, Thomas B., 32
Buttrick, Mrs. T. Lynn, 44
Byerly, M. Paul, 13, 71
Byerly, Walter Houch, 105
Byrd, Harry Clifton, 7, 32, 111
Byrnes, Bernard Joseph, Jr., 105
Caldwell, Lucille J., 15, 27, 67
Callaway, Enoch, Jr., 15, 84
Campbell, Donald B., 25
Campbell, Robert, 109
Caplan, Lester H., 18, 28, 80
Cappuccio, Joseph P., 15, 24, 67
Carey, Richard A., 13, 71
Carey, T. Nelson, 8, 9, 23, 26, 34, 70, 92
Carmel, Sister M., 32
Camey, Mary Kathleen, 106
Carr, C. Jeleff, 8, 9, 81, 92
Carroll, Charles Fisher, Jr., 105
Carroll, Elizabeth, 91
Carroll, John Edward, Jr., 103
Carson, Jack Oliver, 103
Carter, Donald Sweetser, 105
Cato, Robert E., 20
Chambers, Earl L., 35
Chambers, John W., 15, 33, 38, 73, 87
Chambers, Thomas R., 8, 11, 33, 86
Chance, L. T., 18, 87
Chapman, Constance, 36
Charbonneau, Aubin, 108
Chenowith, Robert, 92
Christensen, Osborne D., 13, 74
Christensen, Thomas A., 15, 80
Christopher, Russell Lee, 98. 99, 101
Cianos, James N., 18, 28, 87
Clapp, Clyde A., 8
Clark, David B., 43
Clarke, Carl Dame, 8, 64
Clayton, Raymond L., Jr., 81, 64
Clemmens, Raymond Leopold, 37, 98, 99, 101
Clift, John Vinton, 105
Clyman, Daniel, 103
Coberth, M. E., 44
Coblentz, Richard G., 8, 9, 23, 33, 41, 73
Codington, John Bonnell, 105
Coffman, Kaohlin Miner, 98, 99, 101
Cohen, Cecelia E., 60
Cohen, Earl, 106
Cohen, Harry, 18, 30, 75, 79
Cohen, Israel, 60
Cohen, Jerome, 105
Cohen, Jonas, 13, 26, 71
Cohen, Morris M., 15, 27, 67
Cohen, Phin, 103
Cohen, Solomon, 98, 99, 101
Cole, William P., Jr., Ill
Collenberg, H. T., 36
Colman, Richard, 43
Colon-Lugo, Salomon, 105
Compton, Beverly C, 8, 12, 25, 29, 30, 42, 68, 76
Conlon, Charles C, 32
Cook, Arthur John, 105
Cook, Sarah, 18, 80
Cooper, Donald D., 18, 35
Cooper, Virginia, 44
Cordi, Joseph M., 15, 35, 39, 80
Cornbrooks, Ernest I., Jr., 12, 22, 25, 29, 30, 42, 68, 76
92, 111
Cotter, Edward F., 12, 22, 23, 71, 74, 92
Cotton, Albertus, 8, 43
Covington, E. Eugene, 30, 76
Cowley, R. Adams, 18, 87, 89
Coyle, Jean Marie, 106
INDEX TO PERSONAL NAMES
121
Crawford, John, 45
Crosby, Robert M. N., 20, 73
Cross, Richard J., IS, 18, 24, 29, 30, 77, 78, 92
Culpepper, Stuart Pitner, 103
Culvell, W. B., 109
Culver, Samuel H., 18, 87
Cunnick, Paul C, 108
Cunningham, Raymond M., 16, 29, 30, 84
Curanzy, Raymond Ralph, 98, 99, 101
Curtis, Martha, 18
Curtis, Raymond M., 41
Cushing, J. G. N., 84
Dack, James L., 22
Dalmav, Louis, 109
Damian, Sister M., 32
Dana, Edward R., 13, 36, 86
Davidson, Charles N., 8, 11, 24, 28, 44, 85
Davies, Ross, 11, 69
Davis, Carl L., 8
Davis, E. Hollister, 18
Davis, George H., 16, 30, .74
Davis, John R., 16, 38, 71
Davis, John R., Jr., 34
Davis, Marvin, 26
Dawson, Patricia, 18
Deane, Garrett E., 25
DeCarlo, John, Jr., 8, 12, 42, 85
Deckelbaum, Joseph, 98, 99, 101
Deckert, W. Allen, 16, 29, 68, 87
Defendini, Efrain Antonio, 106
DeHoff, John B., 16, 26, 71, 82
Demarco, S., Jr., 33
Dennis, John M., 16, 24, 28, 86
Dettbarn, Ernest Albert, 98, 99, 101
DeVincentis, Michael L., 18, 33, 37, 87
Devlin, Andrew Joseph, 103
Dice, Kathryn, 13, 84
Dickey, Francis G.( 13, 22, 27, 68, 71, 92
Diehl, William K., 12, 25, 29, 30, 42, 68, 76, 92
Diggs, Andrew Monroe, 103
Diggs, Everett S., 12, 22, 25, 29, 30, 42, 68, 75
Di Giovanni, Anthony John, 103
DiPaula, Anthony, 39
Dillinger, Karl A., 37
Dixon, D. McClelland, 13, 74, 79, 92
Dobbs, Edward C, 9, 24, 67
Dodd, William A., 16, 18, 30, 36, 39, 68, 75
Doeller, Charles H., Jr., 16, 30, 36, 39, 68, 75
Doerner, Wynand Francis, Jr., 105
Dormer, Leon, 98, 99, 101
Doran, William Francis, 106
Dorman, J. William, 43
Dorsey, Brice M., 9, 24, 29, 66
Douglas, Robert Arnold, 103
Douglass, Louis H., 8, 9, 22, 24, 43, 74, 92, 111
Douglass, Robert Corl, Jr., 103
Dowell, Rowland Judson, 105
Dudley, Winston Clark, 98, 100, 101
Duffy, William C, 16, 36, 39, 68
Dumler, John C, 12, 25, 29, 30, 68, 76, 92
Dumler, John D., 105
Dunford, William Stanley, Jr., 103
Dunn, George Mitchell, Jr., 26, 98, 100, 101
Dunnagan, William Andrew, 98, 100, 101
Dunnigan, William C, 18, 33, 37, 87
Durlacher, Stanley H., 14, 70
Dwyer, James R., 109
Eakle, Burke Eldridge, 103
Eastland, J. Sheldon, 11, 34, 38, 70, 92
Eaton, Jay W., 61
Eckert, Herbert Lewis, 103
Edlow, Ernest S., 16, 35, 36, 39, 68
Edlow, Jules Bernard, 105
Edmunds, Page, 8
Edwards, Arthur George, Jr., 106
Edwards, Charles Reid, 8, 9, 22, 23, 44, 86, 89, 92,111
Edwards, David Everett, 98, 100, 102
Edwards, Monte, 8, 9, 24, 29, 42, 83, 86
Edwards, Ruth Page, 20, 84
Edwards, William Hunter, Jr., 98, 100, 102
Egan, Richard F. C, 20, 83
Egbert, Lawrence Deems, Jr., 103
Ehrensberger, Ray, 10, 30, 86
Elderkin, Clarence E., 32
Elgin, Lee William, Jr., 103
Elgin, William W., 12, 84
Ellen, Marie, Sister M., 32
Ellin, Morton Jack, 106
Elliott, Charles Stanley, 103
Ellis, Francis A., 12, 23, 27, 34, 39, 67
Epstein, Yale, 106
Erlanger, Anna H., 44
Erwin, John J., 14, 35, 36, 39, 68
Esch, Victor H., 25
Esmond, William George, 98, 99, 100, 102
Evans, Henry C, 32
Evans, John E., 25
Evans, Otis Druell, Jr., 98, 100, 102
Evans, Theodore Edward, 106
Ewertz, Henry, 44
Eye, Harry Luke, 105
Faraino, Frank A., 20, 89, 108
Farber, Robert E., 109
Fargo, Leon K., 14, 34, 38, 90
Fassel, Mary S., 20, 81
Fax, Betty J., 21, 85
Fearing, William L., 14, 23, 27, 74, 92
Feldman, Maurice, 12, 35, 38, 67
Feldman, Maurice, Jr., 16, 35, 38, 72
Felton, Lloyd D., 10, 65
Ferber, Leon, 28
Ferguson, Charles Kirkpatrick, 98, 100, 102
Ferguson, Frederick P., 8, 11, 83
Ferris, John A., 37
Feski, Joseph Paul. 103
Fields, Ann, 106
Figge, Frank H. J., 8, 10, 63, 91, 92
Filtzer, David L., 43
Finberg, Lawrence, 42 »
Fine, Jack, 103
Fine, Morris A., 16, 26, 29, 72, 90
Fineman, Jerome, 12, 35, 80
Finesinger, Jacob E., 8, 9, 10, 22, 23, 84, 92
122
INDEX TO PERSONAL NAMES
Finkelstein, A. H., 8, 11, 22, 23, 28, 80, 92
Firor, Hugh Valentine, 105
Fisher, Donald E., 14
Fisher, Russell S., 11, 70, 92
Fisher, William H., Jr., 14
Fitch, Charles Thomas, 106
Fitzgerald, Joseph Carroll, 26, 98, 100, 102
Fitzgerald, Shirley K., 18, 64
Fitzpatrick, William N., 19, 28, 84
Flack, Horace E., Ill
Flax, Leonard Harold, 105
Fleitzer, Marjorie R., 19, 84
Fleming, Arthur R., 112
Flynn, Philip D., 16, 35, 38, 68, 71, 72
Foard, W. H., 109
Foley, Michael Joseph, 103
Ford, Frank R., 43
Forrest, Otto Norman, Jr., 106
Fort, Wetherbee, 12, 35, 71, 91, 111
Foul, Charles R., 109
Fox, Samuel L., 16, 29, 78, 83
Framm, Daniel Herschel, 106
Frances Louise, Sister M., 32
Frank, Samuel Leon, 58
Freed, Malcolm Felix, 106
Freedom, Leon, 11, 23, 27, 74
Freeman, Irving, 14, 71
Freimuth, Henry C, 14, 70
Frenkil, James, 109
Frey, Edward L., Jr., 35, 38
Friedenwald, Edgar B., 8, 35
Friedman, Joseph, 109
Friedman, Paul N., 16, 24, 30, 77
Frieman, Sylvan, 105
Fritz, George Suppes, 106
Fritz, Louis Albert, 103
Froehlinger, Richard A., 32
Fruth, Richard Lawrence, 106
Fullilove, Jack, 98, 100, 102
Funk, Audrey M., 16, 66, 71
Funkhouser, George Richard, 106
Furman, J. Earle, 112
Furman, Joseph E., 25
Furnari, Joseph C, 16, 26, 72
Fusco, J. D., 34, 40
Futterman, Perry O., 16, 27, 66, 72
Gable, Walter DeLay, 107
Gaither, A. Bradley, 58
Gallaher, James Patrick, 98, 100, 102
Gallaway, Enoch, III, 28
Galvin, Gerald A., 36, 39, 68
Galvin, Thomas K., 32, 35, 36, 39, 111
Galvin, William L., 32
Ganey, Joseph B., 19, 25
Garcia-Palmieri, Mario Ruben, 98, 100, 102
Gardner, Francis Sidney, Jr., 98, 100, 102
Gardner, Maude M., 44
Gareis, Louis C, 16, 43, 75, 79
Garlick, William L., 11, 33, 41, 87, 89
Garlock, Frederick Adams, 105
Garrett, Richard M., 19, 28, 63, 87, 88
Garrison, Joseph Shermer, III, 105
Gaskel, Jason H., 16, 34, 38, 77
Gates, John Butler, 98, 100, 102
Gaver, Grayson W., 10, 24, 67
Gebhardt, Robert William, 103
Gehrmann, Frederica, 60
Gellman, Moses, 8, 11, 24, 29, 43, 77
Geraghty, Frank J., 12, 23, 71
Geraghty, William R., 19, 87
Gerwig, John Monroe, Jr., 107
Gessner, John Edward, 107
Gevas, George, 105
Gibbs, Gordon E., 8, 11, 23, 80
Gigliotti, Russell, 67
Gilbert, Richard A., 25
Gilliam, Charles Franklin, 103
Gillis, Andrew C, 8
Gillis, Francis W., 12, 34, 38, 90
Gillotte, Joseph Patrick, 105
Ginsburg, Leon, 44
Gislason, Paul Harold, 103
Glick, Leonard Barry, 12, 28, 80
Glick, Louis Michael, 107
Glick, Samuel S., 12, 28, 80
Glinos, Eleanor G. B., 21, 65
Godlove, J. Carlton, 108
Go-kiatsv, Frederick, 20
Goldsmith, Harry, 35
Goldsmith, Ralph Samuel, 107
Goldstein, Albert E., 12, 79, 92, 111
Goldstein, Marvin, 19, 26, 72
Goldstein, Robert Bruce, 105
Golley, K. W., 35
Golombek, Leonard H., 109
Golton, Harold, 24
Gonzales, C. E., 19
Gonzales, C. R., 28
Gonzalez, Caridad E., 81
Gonzalez, Luis Felipe, 103
Goodman, Howard, 19, 28, 81
Goodman, Julius, 33
Goodman, Louis E., 30, 87
Goodman, Louis F., 76
Gordon, Benjamin Dichter, 98, 100, 102
Gore, Jay Calvin, 103
Gorman, Mary, 36
Gorten, Martin K., 20, 25
Govatos, George, 12, 87, 88
Grabill, James Rodney, 104
Graham, David Eric, 104
Granoff, H. L., 16
Graves, Joseph W., 108
Gray, David B., 108
Graybill, Clarence Edward, 104
Greco, William Richard, 104
Grenell, Robert G., 12, 84
Griswold, Robertson, 111
Gross, Earnest, 43
Gross, Gertrude, 28, 84
Grubb, Robert Alvin, 104
Guido, Angelina, 25
Gundry, Alfred T., Ill
Gundry, Lewis P., 11, 23, 30, 70, 92, 111
INDEX TO PERSONAL NAMES
123
Gunning, Jean Jacques, 107
Gutman, Isaac, 16, 34, 38, 42, 77
Hachtel, Frank W., 8, 9, 10, 64, 92
Hahn, Robert H., 22
Haines, John S., 14, 34, 38, 90
Hall, Howard E., 22
Hall, Robert Lee, 107
Hambeny, Leonard Gerard, 37
Hammer, Charles John, Jr., 107
Haneke, August B., 32
Hankin, Samuel J., 16, 71, 82
Hankins, John R., 25
Hankoff, Leon Dudley, 104
Hannan, Alice R., 40
Hannan, Leon, 40
Harmon, John B., 20, 81
Harne, O. G., 8, 9. 11, 63
Harne, William G., 81
Harris, William Benjamin, 104
Harrison, Harold E., 42
Hartman, John Frederick, 107
Hartman, John McMaster,' 105
Hartz, Alvin J., 14, 26, 42, 71
Hartz, Jerome, 92
Harvey, Harold Dewey, 107
Harvin, Marie, 90
Hatem, Frederick Joseph, 98, 100, 102
Hatfield, William Henry, Jr., 107
Hawkins, Charles W., 16, 90, 92
Hawkins, Hermione Hunt, 19, 84
Hayes, James Westcott, 107
Hayleck, Mary L., 16, 28, 80
Headley, William McKendree, 21, 107
Healy, Robert F., 16, 87, 111
Hebb, Donald G., 16, 19, 29, 41, 84,r89
Heimer, William Lenox, 104
Heisse, John Wilbur, Jr., 105
Heldrich, Frederick, Jr., 37
Helfrich, Raymond F., 14, 33, 87
Helfrich, William G-, 16, 22, 71, 82, 88
Hellen, L. Ann, 16, 66, 71
Hendrickson, Carolyn F., 21, 83
Henson, Kenneth Clifford, 105
Herbert, Thomas Franklin, 105
Herbst, Edward J., 8, 12, 65
Herman, Nathan B., 92
Herrmann, Ernest C, Jr., 21, 65
Herspberger, W. Grafton, 14, 71, 82
Hess, Charles Franklin, 105
Hefrick, Horace Bruce, 60
Hibbitts, John T., 14, 68
Hicks, Hugh H., 11, 24, 67
Hidey, Robert M., Jr., 25
Highstein, Benjamin, 27, 109
Hightower, John A., 22, 25
Himmelfarb, Sylvia, 19, 83
Himmelwright, George Overton, 105
Himwich, Harold E., 15, 83, 84
Hirschfeld, John H., 19, 24, 42, 78
Hirshman, Philip J., 109
Hitchcock, Charles M., 59
Hitchman, Irene L., 109
Hoffberger, Samuel H., 32
Hoffman, Lloyd A., 109
Hogan, John F., 12, 29, 90
Holcombe, Robert Calkins, 21, 107
Holder, William Lewis, 105
Hollander, Mark B., 16, 27, 67
Holljes, Henry W. D., 14, 30, 71
Holmes, Charles Martin, 104
Hooper, Z. Vance, 14, 27, 68
Hopf, Edward Warren, 107
Hopkins, John V., 19
Hopkins, Robert Charles, 98, 100, 102
Horine, Cyrus F., 8, 11, 86
Hornbaker, John H., 109
Houck, Romulus Vance, Jr., 104
Houpt, William Pierre, 107
Howell, Clewell, 14, 80
Hubbard, Dorothy H., 20, 65
Hudgins, William Baird, 104
Hudson, Rollin C, 19, 27, 72
Hudson, Willard P., 109
Hughes, A. B.( 109
Hull, Harry C, 8, 10, 23, 25, 86, 89, 92, 111
Hummel, Leonard M., 58
Hundley, J. Mason, Jr., 8, 9. 10, 22, 29, 30, 42, 6S, 76,
88, 92
Hunt, Thomas Edward, Jr., 107
Hunter, DeWitt T., 63
Hunter, DeWitt Talmade, Jr., 104
Hutchins, Elliott H., 8, 10, 32, 33, 86, 89
Hyatt, Irvin, 104
Hyman, Calvin, 16, 87
Iliff, Charles E., Jr., 42
Ingalls, G. S., 28
Inman, Conrad L., 16, 24, 34, 40, 67
Ireland, Charles, 37
Isaacs, Benjamin H., 19, 34, 39, 78
Iten, George Joseph, 98, 100, 102
Jacobsen, Meyer W., 14, 27, 71
Jaffe, Albert, 11, 80
Jaffe, Marvin, 20, 28, 84
Jarrett, Henry K., Jr., 19, 90
Jennings, Erwin R., 25, 108
Jennings, F. L., 8, 10, 33, 86
Jensen, Meredith N., 108
Jeppi, Joseph V., 33, 34, 40
Jerardi, Joseph V., 14, 33, 37, 87, 89
Jewett, Hugh J., 14, 42, 90
Johnson, Edward S., 8, 11, 86
Johnson, Elizabeth, 36
Johnson, Frederick Miller, 98, 100, 102
Johnson, Wallace Edward, 98, 100, 102
Johnson, Wedon, 11, 63
Johnstone, Douglas E., 42
Jones, Everett D., 19, 29, 34, 38, 42, 77
Jones, Henry Albert, Jr., 105
Jones, Richard Arvin, 107
Jones, Rosella Edith, 107
Jones, Thomas Lawson, 105
Joslin, C. Loring, 10, 23, 80
Judge, Walter Francis, 105
124
INDEX TO PERSONAL NAMES
Kader, Marshal I., 16, 30
Kaese, Werner Erich, 105
Kallins, Edward S., 16, 27, 71, 72
Kaltreider, D. Frank, 8, 11, 24, 43, 74. 92
Kammer, William H., 35, 38
Kammer, William H., Jr., 16, 71
Kandel, Arthur, 19
Kane, Harry F., 16, 36, 39, 68
Kaplan, Irvin Bernard, 107
Kardash, Theodore, 16, 20, 29, 30, 68, 75, 79, 92
Karfgin, Arthur, 14, 35, 38, 71
Karfgin, Walter E., 14, 26
Karlinsky, Leo, 59
Karn, William Nicholas, Jr., 105
Karns, Clyde F., 16, 87
Karns, James R., 8, 14, 26, 53, 71
Kashchel, Paul Edward, 98, 100, 102
Kasik, Frank Thomas, Jr., 37
Kayser, Fayne A., 14, 34, 39, 78
Keadle, Robert F., 109
Keefe, Raymond Bernard, 107
Keil, August, 73
Keller, Franklin Lloyd, 104
Kelley, Vernon C, 19, 30, 75
Kellogg, W. K., 61
Kemick, Irvin B., 16, 27, 72
Kemler, Joseph I., 14, 33, 76
Keown, Lauriston L., 19, 26, 72, 82, 109
Kern, Douglas O., 25
Kessler, Gerald, 20, 65
Kevin, Sister M., 36
Kiel, August, Jr., 25
Kiester, Thomas Edward, 107
Kilby, Walter L., 8, 9, 10, 22, 24, 28, 85
Kindt, Willard Freed, 98, 100, 102
King, Joseph, 43
King, Victor Francis, 98, 100, 102
Kingsbury, Robert Coburn, 105
Kinney, Marian L., 40
Kipnis, David Morris, 98, 100, 102
Kirk, Florence R., 90
Kirkpatrick, Crawford N., 43
Kiser, William Sites, 105
Kitlowski, Edward A., 8, 10, 28, 33, 38, 42, 44, 83,
Kitts, Albert W., 14
Kleiman, B. S., 109
Klemkowski, Irvin P., 19, 30, 75
Kline, Frank Menefee, 104
Klohr, Edward Smith, Jr., 107
Knapp, Hubert C, 35
Kneisley, B. B., 109
Knell, Joseph Anthony, Jr., 114
Knight, Arthur Clyde, 105
Knipp, George A., 109
Knipp, Harry Lester, 98, 100, 102
Knotts, Benjamin Franklin, Jr., 107
Knowles, F. Edwin, Jr., 8, 9, 12, 22, 24, 30, 33, 76
Kochman, Leon A., 16, 72, 82
Kohl, Schuyler G., 16
Kohler, Goerge A., 109
Kolman, Lester N., 109
Koontz, Amos, 41, 88
Krager, John Martin, 104
Krahl, Vernon E., 8, 11, 63, 92
Kramer, Bernard, 21, 65
Kramer, Howard Calvin, 37, 98, 100, 102
Kramer, Irvin, 104
Krantz, John C, Jr., 8, 9, 10, 81, 91, 92
Krause, Louis A. M., 8, 10, 23, 26, 34, 43, 69, 70.90,92,
111
Kreig, Edward L. J., 16, 79
Kremen, A., 16, 77
Krieger, Morton Morris, 104
Kroll, Louis J., 14, 71, 82
Krulevitz, K. K., 109
Kuntz, David H., 108
Kyper, Frederick T., 11, 24, 42, 78
LaForge, Elizabeth, 14, 84
Lamb, William Eugene, 98, 100, 102
Lambert, Robert Young, 105
Landowne, Milton, 43
Langelutig, H. Vernon, 12, 34, 42, 71
Langenf elder, Henry E., 26
Langrall, Harrison Morton, Jr., 105
Lanning, Theodore Reuney, 98, 100, 102
Lapp, Herbert Walter, 104
Laster, Anne McNicholas, 21
Lauer, Raymond M., 19, 27, 72
Lavenstein, Arnold F., 28, 80, 92
Lavine, Stafford A., 107
Lavy, Louis T., 109
Lazguskas, Algert P., 16, 30
Leach, C. Edward, 12, 23, 27, 71, 92
Lederman, Alfred S., 19, 68
Lee, Benjamin Buck, 105
Legge, Kenneth D., 8, 10, 34, 38, 90
Legum, Samuel, 14, 71, 82
Leibman, Jack, 98, 100, 102
Leigh ton, Herbert Houck, 105
Lennon, William E., 110
Lensen-Lambros Byruth, 109
Leonard, Robert G., 20, 65
Lerman, Lee R., 19, 27, 67
Lerner, Philip F., 12, 35, 39, 74
Leslie, Franklin E., 19, 72, 82
LeVan, Gerald W., 109
Levicus, Herbert, 26
Levin, H. Edmund, 14, 65
Levin, Herbert Joseph, 107
Levin, Manuel, 27
Levine, Hilbert Merrill, 107
Levine, Leon, 108
Levine, Robert Lee, 105
Levy, David Alfred, 107
Levy, Kurt, 14, 26, 71
Ley, Leo Henry, Jr., 98, 100, 102
Lieberman, Alfred T., 42
Lightbody, Charles Harry, 104
Ling, Johnson S. L., 20, 81
Link, V. Harwood, 16, 26, 27
Linthicum, Milton C, 38
Lisansky, Ephraim T., 12, 22, 23, 28, 71, 79, 84, 92
Lister, Leonard Melvin, 98, 99, 100, 102
Locher, R. W., 8, 11, 33, 86
Lock, Burton V., 19, 38, 72
INDEX TO PERSONAL NAMES
125
Loechel, William E., 20, 63
Loewald, Hans W., 12, 28, 84
Loker, F. Ford, 16, 33, 37, 87, 89
Long, Edgar F., 7
Long, W. Newton, Jr., 43
Long, William B., 14
Longo-Cordero, Rafael, 105
Looff, David Henry, 107
Looper, Edward A., 8, 10, 24, 44, 78
Loughney, Frances V., 40
Love, Robert George, 104
Love, William S., Jr., 8, 11, 23, 70, 92
Lovejoy, Arthur O., 7
Lovitt, William V., Jr., 70, 92
Lu, Go, 20, 81
Lusby, Frank F., 109
Lutz, John F., 8, 12, 55, 63
Lynn, William D., 19, 28, 87
MacDonald, James Melvin, 98, 100, 102
MacDonald, Rodger K., 43
Mack, H. Patterson, 14, 63
Madge, Gordon Evans, 105
Maginnis, Helen I., 16, 29, 68
Magness, Stephen L., 109
Magladery, J. W., 43
Manganiello, Louis O. J., 17, 20, 73
Mansberger, Arlie R., 25
Mansberger, Arlie R., Jr., 20
Mansdorfer, G. Bowers, 14, 35, 38, 80
Mansfield, W. Kenneth, Jr., 19, 75
Marburg, Rudolph, 28
Marek, Charles B., 17, 29, 68
Markowitz, Milton, 42
Marrazzi, Amedo S., 15, 81
Marriott, Henry J. L., 12, 35, 38, 71
Marsh, James T., 109, 110
Martin, Clarence W., 19, 30, 75
Maryanov, Lawrence, 109
Maser, Louis R., 109
Maseritz, I. H., 14, 34, 38, 77
Mathews, Marion W., 17, 28, 84
Mathews, William Allen, 104
Matthews, Mary A., 115
Mawhinney, Charles, Jr., 107
Maxson, Charles W., 8, 11, 33, 86
Mays, Howard B., 12, 24, 29, 42, 79, 90, 92
McCafferty, Robert E., 17, 63
McCaffrey, Henrietta, 36
McCarthy, Harry B., 44
McClafferty, William J., 14, 70
McCormick, Charles P., 7
McCrumb, Fred R., Jr., 92
McCurry, Don Meredith, Jr., 105
McElroy, James W., 32
McElwain, Howard B., 19, 33, 87
McFadden, Archibald Weems, 105
McFadden, Earl Boyd, 98, 100, 102
McFadden, John William, 98, 100, 102
McFaul, William M., Jr., 33
McGonigle, John Jerome, Jr., 107
McGrady, Charles Winifred, Jr., 98, 100, 102
McGrady, Kathleen Reilly, 98, 100, 102
McHenry, D. J., 17, 30, 77
McKay, John Nelson, 104
McKenzie, W., Raymond, 14, 34, 78
McLaughlin, Francis J., 17, 84
McLean, George, 12, 34, 67, 70
McMillin, Parker J., 41
McNally, Hugh B., 12, 24, 35, 74, 92
McNinch, Eugene R., 20, 25, 86
McNinch, James R., 25
Mech, Karl F., 12, 28, 63, 79
Medina, Jose, 17, 30
Mendelsohn, Ronald Edward, 105
Mendez-Bryan, Ricardo Tomas, 98, 100, 102
Meranski, Israel P., 17, 35, 39, 80
Merkel, Joseph R., 21, 65
Merkel, Walter C, 11, 36, 79
Merrill, George G., 14, 23, 35, 39, 74
Merritt, Jeanne, 36
Metcalf, John S., Jr., 26, 98, 100, 102
Metcalf, John William, Jr., 105
Meyer, Mary, 36
Michael, Thomas D., 19, 24, 25, 29, 87
Michaelis, Moritz, 14, 84
Middleton, Benjamin Martin, 105
Might, James Edward, 105
Miksinski, B. W., 43
Miles, Leslie Roy, Jr., 106
Millan, Lyle J., 14, 24, 29, 90
Miller, Carolyn Mae, 21, 85
Miller, George Henry, 106
Miller, James P., 17, 24, 29, 43, 77
Miller, John H., 43
Miller, Joseph M., 15, 87
Miller, Norman Louis, 106
Miller, Victor D., 109
Minnick, Cannela E., 36
Minor, James V., Jr., 24
Mintzer, Donald, 19, 26, 72
Mitchell, George W., 34
Mockowich, Stephen C, 109
Moore, Hilda E., 90
Moore, Robert A., Jr., 26
Moores, J. Duer, 17, 30, 76, 87
Morgan, Zachariah, 8, 12, 67
Morris, Frank K., 14, 35, 36, 39, 68, 111
Morrison, J. Huff, 14, 30, 74
Morrison, Samuel, 11, 23, 67, 70, 92
Morrison, Theodore H., 8, 10, 67
Morton, Allen W., 32
Moss, Irwin H., 21, 107
Mosser, Robert Schaaf, 26, 98, 100, 102
Moulton, G. Allen, 109
Mower, Charles L., 109
Moxness, B. A., 109
Mueller, Charles Herbert, Jr., 107
Mueller, Eugene Alexander, 107
Muller, S. Edwin, 14, 35, 38, 40, 66, 71
Murdock, Anne, 36
Murdock, Harry M., 12, 84
Murphy, John Daily, 107
Muse, Joseph E., Jr., 17, 26, 71, 82
Musser, Ruth, 17, 81
Muth, Frances, 36
126
INDEX TO PERSONAL NAMES
Mutter, Arthur Zelig, 98, 100, 102
Myerowitz, Joseph R., 109
Myers, Carl A., 19
Myers, Carl F., 72, 82
Myers, Donald Johnson, 98, 100, 102
Myers, John A., 17, 71
Myers, Joseph C, 19, 72
Nafzinger, Moses Leroy, 107
Nangle, Gerald Francis, 107
Needle, N. E., 109
Nelson, Alfred T., 8, 9, 10, 22, 24, 42, 63
Nelson, James W., 11, 33, 39, 86
Nelson, S. Page, 32, 89
Newell, H. Whifman, 8, 11, 23, 27, 84, 92
Newman, John W., 25
Nichols, J. Pomeroy, 21
Nichols, Pomeroy, Jr., 19, 21, 37, 73
Nimmo, Jean D., 21, 65
Nitsch, Norbert C, 109
Nolan, James J., 17, 27, 35, 38, 72
Nork, Kurt H., 22
Novenstein, Sidney, 109
Novey, M. Alexander, 13
Novey, Riva Esther, 106
Novey, Samuel, 28, 84
Noya, Joseph, 107
Nuttall, Ernest B., 7, 10, 24, 67
Nygren, Edward Joseph, 98, 100, 102
O'Connor, John A., 33
O'Donnell, Charles F., 38, 109
Olsen, Richard Young, 104
O'Rourk, Thomas R., 8, 11, 24, 78, 79
Orth, John Stambaugh, 98, 100, 102
Osborne, John C, 19, 35, 38, 72
Oster, Robert, 73
Otenasek, Frank J., 17, 33, 38, 73, 92
Owens, David, 107
Owings, James C, 41
Ozazewski, John C, 19, 25, 30, 77
Pacienza, F. A., 33, 40
Packard, A. Gibson, 21, 63
Packard, Albert Gibson, Jr., 107
Packard, Douglas Richard, 98, 99, 100, 102
Palese, John M., 39
Palmisano, Joseph Frank, 106
Pangborn, Thomas W., 32
Parent, Charles-Henri, 108
Parham, S. Malone, 25
Parker, Robert T., 17, 72, 92
Parrott, Frank S., 108
Pats, Albert S., 107
Patten, David Hales, 107
Patterson, J. Milton, 7
Paula Marie, Sister, 36
Peake, C. W., 8, 11, 87
Peck, George Charles, 106
Pembroke, Richard H., Jr., 17
Pencheff, Dorris Marie, 98, 100, 102
Penton, Robert S., 108
Penton, Sim, 21, 25, 37, 89
Parez Arzola, Miguel, 107
Perilla, Frank Robert, 37, 98, 99, 100, 102
Perry, Benton Bloch, 104
Perry, Henry David, Jr., 26, 98, 100, 102
Pertz, Elden H., 35
Pessagno, Daniel J., 8, 10, 33, 86, 89, 110, 111
Peters, H. Raymond, 8, 10, 32, 34, 36, 38, 70
Phelan, Patrick C, Jr., 14, 33, 37, 63, 87
Phelps, Winthrop M., 43
Pierpont, Ross Z., 14, 19, 63, 87, 88, 92
Pillsbury, William Andrew, Jr., 104
Pincoffs, Maurice C, 8, 9, 10, 22, 23, 26, 32, 34, 70, 92
Plummer, Harold B., 109
Polanco, Gerardo B., 21, 76, 79
Polek, Melvin F., 37
Poole, Ernest F., 109
Poole, Frank, 108
Porterfield, M. C, 109
Potter, Vance Edward, 104
Powder, James Richmond, 106
Powell, John Walker, 21, 85
Pratt, Louis J., 109
Preinkert, Alma H., 7
Preis, Kyrle W., 10, 66
Proctor, Samuel E., 17, 28, 87
Pruitt, Hazel Y., 19
Pryor, Carol G., 25
Queen, J. Emmett, 17, 35, 38, 72
Quinlin, Jeanne Ann, 19, 83
Raab, Hellmugh, 107
Rabinowich, Malcolm Lee, 104
Rainess, Morris, 107
Ramirez-Sanisteban, Gilberto, 104
Ramsey, James H., 19, 79
Ramsey, Wilbur O., 24, 67
Randolph, Kenneth V., 10, 24, 67
Rappeport, Jonas Ralph, 104
Raskin, Howard F., 37
Raskin, M., 33, 40
Rasmussen-Taxdal, David Samuel, 104
Rathbun, Howard K., 42
Rawlins, John C, 109
Rayner, Jeannette F., 21, 85
Read, James Lamar, 106
Reed, Julian Ward, 104
Reese, J. Morris, 9, 11, 24, 43, 74, 91, 92
Reeser, Guy McClelland, Jr., 98, 100, 102
Reeves, Henry Gray, Jr., 26, 98, 100, 102
Rehrberger, John M., 20, 24, 29, 78
Reid, John R., 10, 84
Reifschneider, Charles A., 9, 10, 23, 41, 69, 86, 89
Reifschneider, Herbert E., 14, 63, 87, 88, 92
Reimann, Dexter L., 9, 11, 23, 79, 92
Reiter, Robert A., 13, 71, 82
Revell, Samuel T. R., Jr., 13, 23, 27, 71
Rever, William B., Jr., 37
Rex, Eugene Braiden, 26, 98, 101, 102
Reynolds, Georgia, 98, 101, 102
Rich, Benjamin S., 15, 29, 34, 44, 78
Richards, Esther L., 42
INDEX TO PERSONAL NAMES
127
Richardson, Aubrey DeVaughn, 26, 9S, 101, 102
Richardson, Joe Bernal, 106
Richmond, Lewis Cass, Jr., 106
Ridgely, I. O., 13, 33, 87
RienhoS, William F., 13, 33
Rienhoff, William F., Jr., 87, 89
Rigdon, Henry L., 92
Robbins, H. O., 109
Robbins, Martin A., 17, 29, 90
Roberts, Robert Revel Richard, 107
Robinson, Daniel R., 17, 33, 37, 87
Robinson, Harry M., Jr., 13, 23, 27, 67, 71
Robinson, Harry M., Sr., 9, 10, 23, 27, 44, 66, 67, 92
Robinson, Ida Marian, 11, 90
Robinson, Raymond C. V., IS, 27, 34, 39, 43, 67, 92
Roemmich, William, 22
Rogers, Harry L., 9, 10, 34, 38, 77, 110
Rolando, Anne H., 61
Rolando, Henry, 61
Rombro, Marvin Jay, 98, 101, 102
Rosson, William Daniel, 104
Rothchild, Irvin, 13
Rothschild, Stanford Z., 7
Rovelstad, Howard 90
Rowe, James Earle, 106
Rowland, Harry Shepard, Jr., 98, 101, 102
Rowland, J. M. H., 8
Rubin, Seymour W., 17, 79
Russo, James, 20, 35, 63
Rysanek, William J., Jr., 17, 36, 39, 68
Saavedra-Amador, Armando, 98, 101, 102
Sacks, Milton S.t 9, 11, 22, 23, 66, 70, 79, 91, 92, 111
Samorodin, Florese, 36
Sanderson, William R., 61
Sargent, George F., Ill
Sartorius, N. E., 109
Savage, John, 13, 24, 43, 74, 92
Scarborough, Clarence P., 17, 33, 38, 42, 83
SchaeSer, John F., 17, 33, 37, 87
Scherlis, Sidney, 15, 27, 28, 71, 92
Scheye, H. W., 110
Schimmel, Bella Faye, 104
Schindler, Richard Elias, 106
SchlenoS, Milton, 107
Schmale, Arthur Henry, Jr., 26, 98, 101, 102
Schmick, William F., 32
Schmidt, Emil G., 9, 10, 65, 92
Scholastica, Sister M., 40
Schoolman, L. R., 110
Schultz, Kathyrn L., 13, 23, 28, 84
Schuman, William, 110
Schwartz, Benson C, 25
Schwartz, Theodore A., 13, 34, 39, 78
Scott, Minette E., 110
Scott, Roger David, 26, 98, 101, 102
Scully, John Thorsen, 98, 101, 102
Seabold, William M., 13, 15, 23, 80
Seegar, J. King B. E., Jr., 17, 30, 75
Seliger, R. V., 44
Sendelback, Bertha, 44
Serra, Lawrence M., 109
Settle, William B., 13, 28, 63, 88, 89, 92
Seymour, William S., 110
Shaffer, Lester M., 109, 110
Shamer, Margaret Gillette, 107
Shapiro, A. Albert, 15, 23, 27, 67
Shapiro, Jerome Edwin, 107
Sharrett, John Oliver, 104
Shaw, Charles E., 17, 26, 27, 72
Shawbaker, Anna, 40
Shea, William Harold Holland, 37, 98, 101, 102
Shealey, Walter H., 109
Sheehan, Joseph C, 17, 36, 38, 68
Sheehan, Lawrence J., 32
Shell, James H., 21, 68
Sheppard, Robert C, 17, 28, 87, 88, 89
Sherman, Jerome, 17, 27, 72
Sherrard, Margaret L., 37
Sherrill, Elizabeth D., 17, 72, 82
Sherry, Samuel Norman, 93, 101, 102
Shipley, Arthur M., 8, 111
Shipley, E. Roderick, 17, 87, 89
Shocat, Albert J., 27, 68
Shochet, Bernard Richard, 107
Shock, Nathan W., 43
Shoff, Mahlon James, 104
Shuman, Joseph Ellyn, 106
Siegel, Benjamin I., 110
Siegel, Isadore A., 13, 24, 74
Silver, Harold M., 43
Simmons, Leslie Dale, 37, 99, 101, 102
Simpson, Marshall Albert, 107
Sindler, Richard Arnold, 104
Singleton, Robert Tiffany, 106
Sipple, Edward N., 37, 98, 101, 102
Sison, Alfredo, 108
Siwinski, Arthur G., 13, 30, 37, 42, 76, 87, 111
Skaggs, Thomas Wayne, 106
Skipton, Roy Kennedy, 26, 99, 101, 103
Skitarelic, Benedict, 15, 79
Slager, Ursula Travgott, 104
Slasman, William Howry, Jr., 106
Slaw, John H., 110
Smith, Andrew G., 9, 13, 65
Smith, Boy Is ton Dandridge, 104
Smith, Dietrich C, 9, 10, 83, 91, 92
Smith, Edward P., 13, 32, 35, 36, 37, 68
Smith, Edward P., Jr., 26, 108
Smith, Frederick B., 9, 11, 35, 38, 80
Smith, George Herbert, 104
Smith, George W., 17, 21, 26, 37, 63, 73
Smith, Joseph Raymond, 107
Smith, Ruby A., 17, 25, 30, 77
Smith, Sol, 13, 34, 38, 66, 71
Smith, W. Conwell, 111
Smith, William H., 9, 11, 70
Smith, William Meredith, Jr., 106
Smoot, Aubrey Cannon, Jr., 104
Smyth, James Walter, 107
Snyder, Merrill J., 17, 65
Solomon, David Milton, 99, 101, 103
Solon, Thomas John, 107
Sonnenfeldt, Gertrude, 110
Spacek, Jane, 90
Spear, Irving J., 8, 23, 44
128
INDEX TO PERSONAL NAMES
Speed, William G., Ill, 43
Speicher, W. G., 110
Spencer, Hugh R., 9, 10, 23, 36, 44, 79, 92
Spragins, Melchijah, 17, 44, 80, 92
Sprite, Norton, 104
Sprunt, Thomas P., 9, 10, 23, 34, 70
Spudis, Edward Verhines, 106
Spurrier, O. Walter, 20, 35, 39, 80
Stacy, Theodore, 42
Stambler, Alvin Abraham, 104
Stang, Doris, 36
Starling, Charles Ray, 104
Stauffer, John Craig, 106
Stauffer, Ralph S., 109
Stebbins, Thomas A., 21, 68, 76
Steele, Elizabeth R., 21
Steers, Edward, 9, 11, 65
Stein, Albert, 61
Steiner, Albert, 20, 29, 78
Stevens, Vesta May, 20, 84
Stevenson, Thomas M., Jr., 64
Stevenson, Thomas McClelland, 20
Stewart, Edward H., Jr., 15, 30, 76, 87,"92, 110, 111
Stinebert, Edward R., 40
Stone, John Hoskins, 37, 99, 101, 103
Stout, Carolyn M., 21
Strauss, George A., Jr., 36
Suarez-Murias, Edward L., 35, 39
Summerson, William H., 15, 65
Sunday, Stuart D., 17, 72, 82
Supic, William T., 17, 29, 34, 40, 84
Sutch, Anna, 27
Sutton, Julian Theoplous, 21, 28, 84
Suttonfield, Virginia, 21, 28, 84
Swain, Robert W., 21, 86
Tabler, Homer E., 109
Tansey, John J., 29, 44, 108
Tappan, Benjamin, 44
Taussig, Helen M., 44
Teeter, James Herring, 107
Teitelbaum, Harry A., 27, 74, 92
Templeton, William Pendleton, 106
Tenner, David, 111
Thames, Rufus, 107
Theverkauf, Frank J., 108
Thomas, Clyde D., Jr., 37
Thomas, Sister M., 32
Thompson, Raymond K., 15, 33, 38, 42, 73
Tobias, Richard Boyd, 99, 101, 103
Todd, Barbara Elizabeth, 22, 85
Tongue, R. Kent, 43
Toomey, Lewis C, 11, 24, 29, 67
Touhey, T. J., 20, 33, 87
Toulson, W. Houston, 9, 10, 24, 29, 40, 90, 92
Towlen, Isidore William, 13, 63
Townsend, F. J., Jr., 110
Townshend, Wilfred H., 27, 71
Townshend, Wilfred H., Jr., 15
Trace, Robert James, 104
Tracy, Harold William, Jr., 107
Trapnell, Henry Rogers, 107
Treiber, Martin William, 106
Trimble, I. Ridgeway, 10, 33, 37, 41; 86
Triplett, William H., Ill
Troutman, Belk Connor, 104
Troxel, James Roy, 106
Truitt, Edward B., 21
Tublin, Ira Nathan, 107
Tucker, Albert L., 22
Tuerk, Isadore, 15, 28, 84
Tumminello, S. A., 35
Tunney, Robert B., 17, 36, 38, 68
Turner, J. McCullough, 9, 11, 83
Turner, Philip C, 7
Turner, Roy B., 20, 21, 73, 79
Twigg, Homer Lee, Jr., 99, 101, 103
Tyson, William Alva Way, 106
Udel, Melvin, 99, 101, 103
Uhlenhuth, Eduard, 9, 10, 63, 92
Ullrich, Harry F., 43
Ullrich, Henry F., 9, 11, 24, 29, 34, 38, 77; 92
Ullsperger, John F., 36, 39
Urlock, John P., 110
Vadoeski, H., 110
Valderas, Jose, 26
Vance, Arnold Leonard, 106
Vandergrift, William D., 17, 79
Vanden Bosche, Edmond G., 17, 30
Vanderlinde, Raymond, E., 9, 13, 65
Van Lill, Stephen J., Ill, 18, 26, 27, 72, 82
Varipatis, Michael, 43
Velez, Baltasar B., 108
Venable, Sidney J., 22
Venrose, Robert James, 99, 101, 103
Veronica, Sister M., 32
Verrone, Anthony C, 108
Vicens, Carlos Nathaniel, 104
Vollmer, Frederick J., 18, 35, 38, 71, 92
Voshell, Allen Fiske, 9, 10, 24, 29, 42, 43, 77, 88; 91
Wadsworth, Gladys E., 18, 63
Waghelstein, Julius, 43
Wagley, Philip F., 43
Wagner, John A., 9, 11, 23, 42, 73, 79, 91, 92, 111
Wagner, Philip S., 13, 84
Walker, Leslie A., Jr., 26
Walker, Robert T., 21
Walker, W. Wallace, 11, 63, 87, 88, 92
Wall, George Henry, 107
Wallace, Scott Pyper, 104
Waller, William K., 15, 26, 71
Walsh, Harry Martin, 104
Walter, Herbert Guy, Jr., 106
Walton, Henry J., 44
Ward, Arthur, 15, 34, 39, 78
Ward, Grant E., 9, 11, 67, 86
Ward, Hugh W., 110
Ward, Margaret Lucille, 22, 81
Warfield, Clarence, 60
Warfield, Genevra, 60
Waring, H. Glenn, 43
Warner, C. Gardner, 9, 11, 42, 79
Warren, Bryan Pope, Jr., 104
INDEX TO PERSONAL NAMES
129
Warthen, William H., F., 11, 69
Watkins, Donald M., 43
Watson, Charles Polk, Jr., 26, 99, 101, 103
Watson, Jack Thomas, 106
Watt, Francis H., 108
Watters, John Lord, 104
Weaver, Karl Hanna, 106
Weber, Annemarie, 21, 83
Weber, Harry, 108
Webster, Joel Stoops, 106
Weekley, Robert Dean, 99, 101, 10
Weeks, Earl, 35
Weeks, Harry Stephen, Jr., 106
Weeks, Howard Nelson, 104
Weeks, William Earl, 20, 28, 80
Weiner, Israel Howard, 106
Weiss, Harold Robert, 107
Weissman, Marcella, 84
Welch, Hugh J., 35
Welliver, Daniel Irvin, 107
Wells, Amy Lee, 22
Wells, Gibson J., 13, 28, 80
Wells, J. B., 110
Wells, Samuel Robert, 109
Welton, William Arch, Jr., 107
Wexler, Jack, 20, 72, 82
Wheelright, Harvey Prarse, 99, 101, 103
White, John I, 21, 83
White, John P., 26
White, Kenneth Howard, Jr., 108
Whitehurst, Mrs. John L., 7
Whittaker, Arthur Vance, 108
Wich, J. Carlton, 20, 28, 35, 80
Wildberger, Albert John, 104
Wild, William Otto, 108
Wilder, Milton J., 13, 24, 29, 42, 43, 77, 92
Wilfson, Daniel, Jr., 15, 71, 82
Wilkinson, John Ross, jr., 104
Will, David R., 28, 87
Willenson, David, 22, 85
Williams, C. Herman, 18, 72
Williams, Charles H., 26
Williams, Charles Ray, 99, 101, 103
Williams, Huntington, 9, 10, 69
Wilson, Charlotte, 90
Wilson, J. D., 110
Winiarz, W. V., 110
Winslow, Randolph, 59
Wise, Walter D., 9, 10, 32, 33, 37, 86, 89, 92
Wiseman, Marcella, 20
Wisong, Georgianna, 44
Wohl, Milton Jack, 108
Wolf, Frederick S., 18, 35
Wolfe, Geraldine F., 20, 63
Wolfe, William D., 58
Wolfel, Donald Anthony, 104
Wolff, T. Conrad, 9, 11, 34, 38, 70, 82
Wollenweber, Henry L., 92
Wolverton, William Roger, 104
Wood, Austin H., 90
Woodward, Theodore E., 9, 12, 23, 70, 92
Wooten, John L., 29, 44
Workman, Joseph B., 21, 72
Worsley, Thomas S., 20, 72, 82
Wright, Robert B., 9, 12, 79, 92
Wylie, H. Boyd, 7, 9, 22, 111
Yeager, George H., 9, 10, 22, 23, 30, 42, 67, 86,
92, 111
Yim, Robert Earl, 108
York, Shelley Clyde, Jr., 99, 101, 103
York, Thomas Luther, 99, 101, 103
Young, Calvin Lessey, 99, 101, 103
Young, Earl S., 109
Young, John D., 24, 29, 42
Young, John D., Jr., 18, 34, 38, 90
Young, Latimer, 28
Young, Ralph F., 109
Young, Richard A., 22, 26, 81
Zangara, Henry F., 26
Zapf, Evelyn Byrd, 44
Zeligman, Israel, 15, 23, 27, 67
Ziegler, Paul R., 37
Zimmerman, Ira M., 109
Zinn, Waitman F., 9, 10, 32, 34, 39, 78
Zupnik, Howard L., 20, 33, 37, 87
Zuravin, Meyer H., 33
8, 89,
The Frank C. Bressler Research Laboratory
University Hospital
Maryland- University. ScJvool a9 me<fjcf'ne . fS)it||e"ti
in
Return this booK on or before the last
date stamped below
T>
<?es
no
4- cv
YTCu. I^O,
Library Bureau Cat. 00. i(7*
Live Music
Archive
Librivox
Free Audio
Metropolitan Museum
Cleveland
Museum of Art
Internet
Arcade
Console Living Room
Open Library
American
Libraries
TV News
Understanding
9/11